Soccer as a novel therapeutic approach to pediatric

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Transcrição

Soccer as a novel therapeutic approach to pediatric
“Soccer as a novel therapeutic approach to pediatric obesity.
A randomized controlled trial of its effects on fitness, body composition,
cardiometabolic and oxidative markers”
Final Report
Principal Investigator
André Seabra - Faculty of Sport, University of Porto
Team Members
Carla Rêgo - Faculty of Medicine, University of Porto; Pediatric Unit CUF Hospital
Alice Silva - Faculty of Pharmacy, University of Porto
Sandra Torres - Faculty of Psychology, University of Porto
Sandra Abreu - Faculty of Nutrition, University of Porto
Luís Belo - Faculty of Pharmacy, University of Porto
Henrique Nascimento – Faculty of Pharmacy, University of Porto
Susana Vale - Faculty of Sport, University of Porto
Elisa Marques - Faculty of Sport, University of Porto
Gustavo Silva - Faculty of Sport, University of Porto
Augusto Pedretti – Faculty of Sport, University of Porto
Manuel Coelho e Silva - Faculty of Physical Education, University of Coimbra
Ana Seabra – Perafita Basic School
José Oliveira - Faculty of Sport, University of Porto
Jorge Mota - Faculty of Sport, University of Porto
March, 31, 2014
CONTENTS
Summary
I. INTRODUCTION………………….…………………………………………….…………………..7
II. STATE OF THE ART……………….....………………………………………….………………..9
III. TASKS AND ACTIVITIES………………………………………………………………………...15
3.1. TASK 1 - Contacts with CUF Hospital (Pediatric Unit) and Faculty of Sport administrations,
parents and children…………………………………………………………………………………..16
3.2. TASK 2 - Baseline data collection, entering data, screening, statistical analysis and
randomization of the intervention groups……………………………………………………………17
3.3. TASK 3 - Soccer and individual intervention programs……………………………..…..….…24
3.4. TASK 4 - Post intervention data collection, entering data, screening and statistical
analysis…………………………………………………………………………………………….…..26
3.5. TASK 5 – Main findings……...…..………………………………………………………….…..27
3.6. Dissemination of the present project in Portuguese Community …………………………...…38
V. CONCLUSIONS……………...…………………………………………………………………...…39
VI. REFERENCES………………..…………………………………………………………………..46
Appendix .….….….….….….….……………………………………………………………………………………………………………. 53
3
Summary
Childhood obesity is increasing dramatically and is associated with the several
cardiometabolic comorbidities. Physical activity has been accepted as an important
mean for its prevention. However, only few studies have investigated the impact of a
team sports intervention on cardiometabolic risk factors (CMRF), inflammatory markers
and cardiorespiratory fitness in obese children. The purpose of the present study was to
examine the effects of a 6-month intervention of soccer practice on the body
composition, CMRF and inflammatory markers, cardiorespiratory fitness and
psychological status of obese children. Eighty eight boys (8-12 yrs; body mass index
[BMI] > than CDC 95th percentile) were randomly assigned to 6-months’ exercise or
non-exercised program: 29 were assigned to a soccer program (SG), 29 were assigned
to a traditional physical activity program (TG) and 30 were assigned as a control group
(CG). The soccer and traditional physical activity programs involved sessions 60-90 min,
3 times/week; average intensity >70-80%HRmax. Both groups participated in two
sessions of 45-90-minutes physical education per week at school. Height, body mass,
waist circumference, blood pressure, fasting blood glucose, high-density lipoproteincholesterol, triglycerides, insulin, adiponectin, leptin, resistin, C-reactive protein, tumor
necrosis factor alpha, oxidized low density lipoprotein cholesterol and maximal oxygen
consumption (VO2max) were evaluated according to standardized procedures. Body
composition was assessed by DXA. Indicators of perceived psychological status
included body image, self-esteem, attraction to participation in physical activity,
perceived physical competence and quality of life measured with standardized
questionnaires. Physical activity levels was monitored with accelerometers for 7 days.
From baseline through 6 months, the two physical activity groups (SG and TG) showed
improvements in body composition, lipid profile, insulin sensitivity, CMRF and
inflammatory status, cardiorespiratory fitness and psychological status compared to the
CG. The improvement in some variables was more apparent in SG than TG. These
findings provide evidence that soccer as a highly popular socially and culturally
meaningful sport accessible to all social strata is a highly effective medium for the
prevention/reduction of childhood obesity and for the enhancement of body composition,
cardiometabolic health, cardiorespiratory fitness and associated psychological status of
obese youth.
5
I.
INTRODUCTION
Childhood
overweight
and
obesity
have
reached
epidemic
proportions
[1].
Approximately 25% of children in developed countries are currently overweight or obese.
Prevalence has doubled in Portugal in the last two decades [2]. The increasing
prevalence of childhood obesity is associated with an increase in cardiovascular and
metabolic risk and comorbidities [3]. Evidence also has suggested that cardiovascular
and metabolic risk factors (CMRF) in youth may persist throughout life even in the
presence of improved nutritional status and may compromise quality of life as well as
life expectancy [4].
For all these reasons, childhood obesity and CMRF represent serious health conditions
that need treatment in order to prevent the development of additional health
consequences. Physical activity has been accepted as an important means for its
prevention [5, 6]. Evidence concerning the effectiveness of physical activity interventions
to tackle childhood obesity and CMRF has been reviewed [6-8]. These studies have
shown positive effects of physical activity on CMRF, body composition and associated
psychological consequences in overweight and obese children. Though interesting,
these studies emphasize a need for further research for three reasons. First, results are
not entirely congruent across studies. Second, sample sizes varied considerably among
studies. And third, physical activity programs varied in intensity, duration, type and
setting. Intervention physical activity programs for overweight and obese children have
generally incorporated a variety of aerobic and resistance activities accommodating
individual differences in physical activity interests (running and walking), and rarely link
children´s interests to team-games and sport activities (see, for example, [7, 9-11].
Current recommendations from select panels and international health organizations [12]
suggest that children should accumulate at least 60 minutes or more of aerobic
moderate- to vigorous-intensity physical activity per day, and to perform muscle and
bone-strengthening activities at least 3 days per week. Participation in activities that are
appropriate for age and enjoyable, and offer variety is recommended [13]. In Portugal,
more than 60% of the children do not reach the recommendations [14]. Factors
responsible for this low compliance are not well understood. A plausible explanation is
probably linked to limited possibilities of undertaking recommended physical activity (i.e.,
type, duration, frequency and intensity) in many school and community settings. Another
7
possible explanation is that children perceive prescribed physical activity as not
enjoyable because it is superimposed by others and not self-chosen. The data for
Portugal are generally consistent with the increasing prevalence of physical inactivity
among children worldwide; it is estimated that about two-thirds of the child population
are insufficiently physically active [15].
Soccer is a popular, affordable, and widely practiced team-sports worldwide and has
been recently suggested as a very effective “tool” in reducing CMRF in adults [16].
Traditionally played as 11 vs. 11, but also as small-sided games (e.g. 3v3, 5v5, 7v7),
football is associated with relatively high energy expenditure and a high aerobic
component, with mean heart rates (HR) of 75-85% of maximum HR [17, 18].
Recreational soccer also involves high impact activities which stimulate the muscularskeletal system. The efficacy of a recreational soccer program on health and fitness of
overweight children has been recently investigated [19, 20]. While no detailed CMRF
were assessed, this novel data suggested that soccer has a high positive effect in weight
control. Given this novelty, we believe that soccer being a highly popular sport, socially
and culturally meaningful and accessible to all social strata has an increased potential
to operate as a highly effective “medicine” for the prevention/reduction of childhood
obesity and CMRF.
Thus, based on a 6-month randomized trial design, this study aimed to provide adequate
answers to the following hypotheses:
(1) Systematic practice of recreational soccer has a significant effect in reducing CMRF
and percentage of body fat, and in improving muscle and bone mass, cardiorespiratory
fitness and associated psychological consequences;
(2) Systematic practice of recreational soccer has a greater effect than other traditional
physical activity intervention program in increasing energy expenditure, reducing CMRF,
and improving body composition, cardiorespiratory fitness and associated psychological
consequences;
(3) With recreational soccer as the template for regular physical activity or reducing the
expression of CMRF, new subsets of markers with greater sensitivity and predictive and
clinical utility will be developed.
8
II. STATE OF THE ART
The increasing prevalence of childhood obesity [1] is associated with an increase in
CMRF and comorbidities [3]. Evidence also suggests that CMRF in youth may persist
(track) throughout life even in the presence of improved nutritional status [21]
compromising the quality of life and its expectancy [4]. Abdominal obesity, high blood
pressure, elevated triglycerides and glucose, and reduced levels of high-density
lipoprotein are commonly clustered as the metabolic syndrome [22]. Although variably
defined, prevalence of metabolic syndrome has increased recently and has reached 1517% among Portuguese obese children [2, 23]. If risk factor aggregation, rather than
traditional criteria for metabolic syndrome, is used, more than one-half of obese children
have two or more risk factors [24]. This approach suggests that classical markers may
not be sufficiently sensitive at pediatric ages and highlight a need to consider other
markers of CMRF. Recent research suggested the existence of other biological markers
associated with pro-inflammatory and pro-oxidant states which are expressed at earlier
ages with greater sensitivity [24, 25]. These novel markers are adiponectin and its
isoforms, leptin, resistin, high sensitivity C- reactive protein (CRP), tumor necrosis factor
alpha (TNF-α) and lipoprotein particularly its oxidized high-density (LDL-ox). Cytokines
are precocious markers of CMRF associated with obesity. Some have a proinflammatory action (TNF-α, IL-6), are significantly higher in the plasma of obese
patients and triggers an increased syntesis of hsCRP [26]. This inflammation may
promote CMRF comorbidities of obesity, namely dislipidemia, insulin resistance and
endotelial disfunction. This is the reason why obesity may be regarded as a state of low
grade inflammation and atherosclerosis. In contrast, adiponectin decreased plasma
concentration in obese is associated with an anti-inflammatory status and an
antiatherogenic and antidiabetic profile, meaning that adiponectin acts as a precocious
and independent biomarker of metabolic syndrome [27].
Childhood obesity and CMRF represent serious health conditions that must be treated
in order to prevent the development of additional health consequences. Physical activity
has been accepted as an important means for its prevention [23]. The evidence
concerning the effectiveness of PA interventions to tackle childhood obesity and CMRF
has been reviewed [6-8]. These studies have shown positive effects of physical activity
on body composition, CMRF, cardiorespiratory fitness and psychological status in obese
children. However, there is a consistently call for future research centered on
9
intervention novelty and innovative biological markers. The inconsistency of available
data involved a wide range in sample sizes, physical activity programs with different
intensities, durations, frequencies and types of activities. Intervention physical activity
programs for obese children have generally incorporated a variety of aerobic and
resistance activities accommodating individual differences in physical activity interests
(running and walking), and rarely link children´s interests to team-games and sport
activities [6, 7].
Current recommendations from select panels and national health organizations [12, 13]
suggested that children should accumulate at least 60 minutes or more of aerobic
moderate-to-vigorous intensity physical activity per day, and to perform muscle and
bone-strengthening activities at least 3 days a week. Participation in activities that are
age appropriate and enjoyable, and offer variety is recommended [13]. In Portugal, more
than 60% of the children do not reach these recommendations [14]. Responsible factors
for this low compliance are not well understood. A plausible explanation is probably
linked to limited possibilities of undertaking recommended physical activity (type,
duration, frequency and intensity) in many school and community settings. Another
possible explanation is that children perceive prescribed PA as not enjoyable because
it is superimposed by others and not self-chosen. Children tend to participate in relatively
short bouts of physical activity. Heart rate (HR) monitoring demonstrates that
recreationally active children perform primarily short bouts of activities (<5min) and
seldom participate in long-sustained activities (>20min) [17].
By inference, physical activity proposed in intervention studies should closely represent
the natural pattern of spontaneous physical activity among the children, thus increasing
enjoyment of the participants. Soccer is one of the most popular, affordable, and widely
practiced team-sports worldwide and has been recently suggested as a very effective
“tool” in reducing CMRF in adults [16]. Traditionally played as 11vs11, but also
conducted as small-sided games (3vs3, 5vs5), it is associated with relatively high energy
expenditure and has a high aerobic component (HR>75max) [17]. Recreational soccer
also involves high impact activities which stimulate the muscular-skeletal system [18].
The efficacy of a recreational soccer program on health and fitness of overweight
children has been recently investigated [19, 20]. While no detailed CMRF were
assessed, this novel data suggested that soccer has a high positive effect in weight
control. Given this novelty, we believe that soccer being a highly popular sport, socially
10
and culturally meaningful and accessible to all social strata has an increased potential
to operate as an effective “medicine” for the prevention of childhood obesity and CMRF.
Given this small number of studies that use soccer as a strategy to prevent childhood
obesity, the next paragraphs intend to summarize the main results that are known about
the effectiveness of physical activity programs on body composition, cardiorespiratory
fitness, CMRF and inflammatory markers in overweight and obese children and
adolescents.
Effect of physical activity on body composition and cardiorespiratory fitness
Table 1 summarizes the effects of physical activity interventions on body composition
and cardiorespiratory fitness variables. Twenty-two studies quantified the impact of
physical activity on BMI [7, 11, 28-46]. Fifteen of these studies were effective in reducing
the BMI [7, 28, 30, 31, 33-40, 42, 46, 47], six studies did not report any significant change
[11, 29, 32, 41, 43, 45], and only one study showed a BMI increase after the intervention
[44]. Of the nineteen studies that measured the percentage of body fat [7, 11, 28-30, 32,
33, 35-40, 42-46], twelve studies have reported a decrease [28-33, 35, 37, 38, 40, 42,
43] and seven studies no change [7, 11, 36, 39, 44-46]. Nine of the 10 studies that
measured waist circumference showed significant improvements after the intervention
programs [7, 11, 31, 33, 38-40, 42, 43]. Only ten studies assessed changes in
cardiorespiratory fitness [29, 31-35, 39-41, 43]. Seven of these studies showed an
improvement in cardiorespiratory fitness [31-33, 35, 39, 40, 43], while three studies did
not report any significant difference pre and post intervention program [29, 34, 41].
11
Table 1. Effect of interventions on body composition and cardiorespiratory fitness.
Study
BMI
Body fat (%)
WC
Cardiorespiratory fitness
Flores [34]
↓
NE
NE
↔
Neumark-Sztainer, Story [41]
↔
NE
NE
↔
Bayne-Smith, Fardy [29]
↔
↓
NE
↔
Watts, Beye [45]
↔
↔ (↓Tr. ↓ Ab.)
↔
NE
Carrel, Clark [32]
↔
↓
NE
↑
Balagopal, George [28]
↓
↓
NE
NE
Nassis, Papantakou [11]
↔
↔
↓
NE
Meyer, Kundt [7]
↓
↔
↓
NE
Melnyk, Small [47]
↓
NE
NE
NE
Kim, Im [38]
↓
↓
↓
NE
Johnston, Tyler [36]
↓
↔
NE
NE
Wong, Chia [46]
↓
↔
NE
NE
Foschini, Araújo [35]
↓
↓
NE
↑
Tjonna, Stolen [43]
↔
↓
↓
↑
Lee, Shin [39]
↓
↔
↓
↑
Van Der Heijden, Wang [44]
↑
↔
NE
NE
Ben Ounis, Elloumi [30]
↓
↓
NE
NE
Johnston, Tyler [37]
↓
↓
NE
NE
Shih, Janckila [42]
↓
↓
↓
NE
Buchan, Ollis [31]
↓
↓
↓
↑
↓(st)
↓(st)
↓(st)
↑(st)
↔(at)
↓(at)
↓(at)
↑(at)
↓
↓
↓
↑
Lee, Bacha [40]
Farah, Ritti‐Dias [33]
BMI, Body mass index; WC, Waist circumference; ↓, Significant decrease in the mean value; ↔, No
significant change in the mean value; ↑, Significant increase of the mean value; Tr., Percentage of fat in
the trunk; Ab., Percentage of fat in the abdomen; NE, Not evaluated st, strength training; at, aerobic
training.
Effect of physical activity on CMRF
Table 2 exhibits the effects of physical activity interventions on blood pressure (BP) and
heart rate (HR). Data on resting BP were available from ten studies [7, 29, 31, 33, 3538, 43, 46]. Seven of the nine studies showed significant decreases in systolic BP (SBP)
after the intervention [7, 29, 31, 33, 35, 43, 46], while three studies did not report
significant changes [36-38]. Ten studies examined the diastolic BP (DBP) [7, 29, 31, 33,
35-38, 43, 46]. Three of them observed a reduction in their values [29, 35, 43], but the
other seven did not report significant changes [7, 31, 33, 36-38, 46]. Only seven studies
12
measured the HR at rest or during submaximal exercise [11, 33, 34, 37, 38, 45, 46]. Four
of them showed a reduction due to the intervention [11, 33, 34, 46], while the other three
did not find significant differences [37, 38, 45].
Table 2. Effect of physical activity interventions on blood pressure variables.
Study
SBP
DBP
HR
NE
NE
↓
↓
↓
NE
Watts, Beye [45]
NE
NE
↔
Nassis, Papantakou [11]
NE
NE
↓
Meyer, Kundt [7]
↓
↔
NE
Kim, Im [38]
↔
↔
↔
Johnston, Tyler [36]
↔
↔
NE
Wong, Chia [46]
↓
↔
↓
Foschini, Araújo [35]
↓
↓
NE
Tjonna, Stolen [43]
↓
↓
NE
Johnston, Tyler [37]
↔
↔
↔
Buchan, Ollis [31]
↓
↔
NE
↓(lit)
↔ (lit)
↔ (lit)
↓ (hit)
↔ (hit)
↓ (hit)
Flores [34]
Bayne-Smith, Fardy [29]
Farah, Ritti‐Dias [33]
BP, Systolic blood pressure; DBP, Diastolic blood pressure; HR, heart rate; ↓, Significant decrease in the
mean value; ↔, No significant change in the mean value; ↑, Significant increase of the mean value; NE,
Not evaluated; lit, low intensity training; hit, high intensity training.
Studies investigating the effects of physical activity on metabolic markers are shown in
table 3. Of the twelve studies that measured insulin level [7, 11, 32, 33, 35, 36, 38-40,
43-45], six reported a decrease [7, 11, 32, 35, 39, 43] and seven did not detect significant
changes [35, 36, 38, 39, 43, 45, 46]. Plasma glucose levels were measured in ten studies
[11, 32, 35, 36, 38-40, 43, 44, 46], most of them reporting significant improvements. Nine
studies examined the response of high-density lipoprotein cholesterol (HDL) to physical
activity interventions and no significant change was reported [7, 35-38, 43, 44, 46].
However, of the seven studies that measured low-density lipoprotein cholesterol (LDL)
levels [7, 35-38, 44, 46], four showed a significant decrease [7, 35-37], while three did
not report significant changes [38, 44, 46]. Five studies showed a decrease in the total
cholesterol level [7, 35-37, 39], but other five did not observe significant changes [29,
38, 44-46].
13
Table 3. Effect of physical activity interventions on metabolic variables.
Study
Insulin
Glucose
HDL
LDL
Total cholesterol
Bayne-Smith, Fardy [29]
NE
NE
NE
NE
↔
Watts, Beye [45]
↔
NE
NE
NE
↔
Carrel, Clark [32]
↓
↔
NE
NE
NE
Nassis, Papantakou [11]
↓
↔
NE
NE
NE
Meyer, Kundt [7]
↓
NE
↔
↓
↓
Kim, Im [38]
↔
↓
↔
↔
↔
Johnston, Tyler [36]
↔
↔
↔
↓
↓
Wong, Chia [46]
NE
↔
↔
↔
↔
Foschini, Araújo [35]
↓
↔
↔
↓
↓
Tjonna, Stolen [43]
↓
↓
↔
NE
NE
Lee, Shin [39]
↓
↑
↔
NE
↓
Van Der Heijden, Wang [44]
↔
↔
↔
↔
↔
Johnston, Tyler [37]
NE
NE
↔
↓
↓
↔(st)
↔(st)
NE
NE
NE
↔(at)
↔(at)
NE
NE
NE
↔
NE
NE
NE
NE
Lee, Bacha [40]
Farah, Ritti‐Dias [33]
HDL, High density lipoprotein; LDL, Low density lipoprotein; ↓, Significant decrease in the mean value; ↔,
No significant change in the mean value; ↑, Significant increase of the mean value; NE, Not evaluated; st,
strength training; at, aerobic training.
Effect of physical activity on inflammatory markers
As shown in Table 4, few studies have investigated the effects of physical activity on
inflammatory markers in overweight and obese children and adolescents. Of the seven
studies that evaluated C-reactive protein (CRP) levels [7, 11, 28, 30, 38, 42, 46], three
showed a reduction [28, 30, 42], three did not report significant changes [11, 38, 46] and
only one study reported an increase after the intervention [7]. Five studies have
examined the response of interleukin-6 (IL-6) to physical activity [11, 28, 30, 38, 42],
three of them showing a significant decrease in their levels [28, 30, 42] and two reporting
no significant change [11, 38]. Three studies evaluated the adiponectin levels [11, 38,
43], two of them detecting an increase in the basal levels [38, 43]. Among the two studies
that measured the fibrinogen levels [7, 28], one reported a reduction [28], but one
showed an increase after the intervention [7].
Table 4. Effect of physical activity interventions on inflammatory markers.
14
Study
CRP
IL-6
Adiponectin
Fibrinogen
NE
NE
NE
NE
Balagopal, George [28]
↓
↓
NE
↓
Nassis, Papantakou [11]
↔
↔
↔
NE
Meyer, Kundt [7]
↑
NE
NE
↑
Kim, Im [38]
↔
↔
↑
NE
Wong, Chia [46]
↔
NE
NE
NE
Tjonna, Stolen [43]
NE
NE
↑
NE
Ben Ounis, Elloumi [30]
↓
↓
NE
NE
Shih, Janckila [42]
↓
↓
NE
NE
Watts, Beye [45]
CRP, C-reactive protein; IL-6, interleukine-6; ↓, Significant decrease in the mean value; ↔, No
significant change in the mean value; ↑, Significant increase of the mean value; NE, Not evaluated.
III. TASKS AND ACTIVITIES
In order to provide adequate answers to the above hypotheses, we proposed a timeline
with several tasks and activities to develop throughout the project. Therefore, this report
will present different tasks and activities implemented.
Table 5. Timeline with tasks and activities developed throughout the project.
June 2013 to March 2014
Tasks denomination
1
(1) Contacts with CUF Hospital and Faculty of
Sport administration, parents and children
(2) Baseline data collection
(3) Soccer and individual intervention programs
(4) Post intervention programs
(5) Writing final report (Main findings)
15
2
3
4
5
6
7
8
9
10
11
12
3.1. TASK 1 - Contacts with CUF Hospital (Pediatric Unit) and Faculty of Sport
administrations, parents and children
Activity 1 - Contacts with the CUF Hospital (Pediatric Unit) and Faculty of Sport
administrations
The CUF Hospital and the Faculty of Sport of the University of Porto administrations
were contacted to discuss the project, its importance and relevance in terms of Public
Health and Education. During the meeting an extensive package with all information
concerning the project was provided. In addition, it was discussed the timeline and
involvement of the Pediatric Unit of CUF Hospital and Faculty of Sport in all the project
phases.
Results achieved: Pediatric Unit of CUF Hospital and Faculty of Sport have authorized
to conduct the project.
Resources allocated to this task: Material related to secretarial work.
Date of task conclusion: May 31th, 2013
Activity 2 - Contacts with the parents and children. Sample selection
A total of 200 children from the Pediatric Unit of the CUF Hospital – Porto were invited
for participation in this project. In order to be included in this study, children had to be
between 8 to 12 years of age, and to have a BMI greater than CDC 95 th percentile for
sex and age-specific [48]. Children using a medication or with diagnosed medical
conditions that would limit their ability to perform activities (e.g., cardiovascular disease,
type I diabetes, renal insufficiency, liver disease) were excluded. Children who
participated in a structured exercise, nutrition and/or weight loss program for at least 1
year prior to the study were also excluded. Of these 90 obese children agreed to
participate. Sample size calculations were performed a priori for repeated measures
ANOVA using the G*Power software 3.1.9.2. Hypothesizing an effect size (Cohen’s d)
of 1.0 [49] for a required power of 95% at p<0.05, a sample size of at least eighteen in
each group was required. Therefore, a larger sample size should provide adequate
power for detecting both differences.
16
This study was ethically reviewed and approved by the research committee of the
Faculty of Sport of the University of Porto and by hospital authorities (#12/2013). It was
conducted in compliance with the declaration of Helsinki. All participating children and
their legal representatives received information sheets and filled out written consent
forms.
Results achieved: Parents and ninety children followed in the Pediatric Unit of CUF
Hospital Porto gave their authorization consents agreed to participate in this study.
Resources allocated to this task: Material related to secretarial work.
Date of task conclusion: June 30th, 2013
3.2. TASK 2 - Baseline data collection, entering data, screening, statistical
analysis and randomization of the intervention groups
Activity 1 - Baseline data collection
The evaluation of the children participating in this project required the completion of two
assessments (baseline and final). The baseline assessment was conducted in the first
week of September 2013 to all participating children at the Faculty of Sport - University
of Porto. The final assessment was conducted in the first two weeks of March 2014 to
all participating children at the Faculty of Sport - University of Porto. The methodology
of this project, although very diverse, focused on seven major areas: (1) anthropometry;
(2) body composition; (3) biological maturity status; (4) CMRF; (5) cardiorespiratory
fitness; (6) perceived psychological status; (7) physical activity and dietary intake. Each
child was tested on two occasions. Anthropometric and body composition measures,
CMRF, and psychological measures were assessed during the initial visit whereas
cardiorespiratory fitness was assessed during the second visit.
(1) Anthropometry
Body mass, height and waist circumference were measured following standardized
procedures. Body mass was measured using a physician’s digital scale (Tanita®, BC418MA, USA) and height using a fixed stadiometer (Holtain Ltd., UK) and waist
circumference with a metallic tape (Holtain Ltd.). BMI (kg/m2) was calculated. The
17
children were classified as obese if they had a BMI greater than CDC 95th percentile for
sex and age-specific [48].
(2) Body composition
Body composition was measured by dual-energy X-ray absorptiometry (DXA) (Hologic
QDR 4500A, Hologic Inc., Waltham, MA, USA), which segments the body into the 3
compartments of fat mass, bone mass, and fat-free mass. The equipment was calibrated
according to the manufactures instruction and well-trained technician made the exams.
Children were scanned in supine position and the scans were performed in high
resolution. Bone mineral content (BMC) and density (BMD) were measured for the whole
body and the lumbar spine (L1–L4) using standard protocols. The same investigator
analysed all total body scans. The principles behind body composition analyses with
DXA are explained elsewhere [50].
(3) Biological maturity status
Stage of pubic hair (PH) was the indicator of biological maturity status. Stage of PH
based on the criteria of [51] was evaluated at clinical examination by a pediatrician
experienced in the assessment of secondary sex characteristics.
(4) Cardiometabolic risk factors
After an overnight fast, between 8.00 and 10.00 a.m. at Faculty of Sport - University of
Porto, blood samples were collected by venipuncture in EDTA containing tubes and
processed within 2 hours of collection, from all participants at baseline and after six
months. Aliquots of plasma were made and stored at -80oC until assayed. Analysis of
baseline and follow up samples were performed in the same day. All blood samples were
analyzed for fasting blood glucose (FBG), high-density lipoprotein-cholesterol (HDL-c),
triglycerides (TRG), fasting insulin, adiponectin (Adip) , leptin (Lept), resistin (Resit), Creactive protein (CRP), tumor necrosis factor alpha (TNF-α), and oxidized low density
lipoprotein cholesterol (LDL-ox). TC and TRG concentrations were determined by
enzymatic colorimetric tests (CHOD-PAP and GPO-PAP methods, Roche, respectively).
HDL-c was measured using a specific enzymatic colorimetric test (Direct HDL
cholesterol, Roche). Low-density lipoprotein-cholesterol (LDL-c) concentration was
calculated using Friedewald formula [52]. The determination of circulating levels of
glucose and insulin was performed by using routine automated technology
(Roche). CRP was determined by a imunoturbidimetry test (Roche). The degree of
18
insulin resistance was estimated with the use of the homeostatic model assessment for
insulin resistance (HOMA-IR) and calculated as the product of the fasting plasma insulin
(µU/ml) and the fasting plasma glucose (mg/dl) divided by 405 [53]. Plasma
concentration of Adip, Lept, Resist (e-Bioscence) and LDL-ox (Mercodia) were
evaluated by commercial enzyme-linked immunoassays (ELISA). Blood samples were
collected by qualified nurses of CUF Hospital. Breakfast was provided to all children
immediately following sampling in the Faculty.
Resting blood pressure (BP) was determined using a digital sphygmomanometer
(OMRON M6) after subjects had been seated for 10 min of rest. Two measures were
taken with a 3-min interval between successive measurements. If the difference between
the first and second measurement, either diastolic blood pressure (DBP) or systolic
blood pressure (SBP), are greater than 10mmHg, a third measurement was taken.
Children were classified according to sex, height and age-specific charts.
(5) Cardiorespiratory fitness
To assess the maximal oxygen uptake (VO2max), all children were submitted to a
continuous progressive treadmill exercise. Children were instructed to walk/run until
exhaustion, according to a standardized exercise protocol [54, 55]. The exercise protocol
started at 4km/h without inclination and maintained for 3 min so that children could adapt
to the treadmill. After 3 min, speed was increased to 8km.h -1. When 5 min were
completed, the inclination was raised to 3%. After 7 and 9 min, the inclination was
increased to 6% and 9%, respectively. If children were able to endure more, the speed
was increased to 9 km/h after 1 min and then 10 km/h after 13 min.
(4) Perceived psychological status
A reduced version of the children's attraction to physical activity scale (CAPA) developed
by Brustad [56] was utilized to measure interest in engaging in physical activity. The
Portuguese-language version includes 14 items designed to measure the extent of
children’s interest in engaging in physical activity. The CAPA includes five dimensions
of attraction to participation in physical activity including attraction to participate in
vigorous physical activity; perceived importance of participating in physical activity; liking
of games and sports; assessments of whether physical exertion is perceived to be fun
or important; and attraction due to perceived peer acceptance in games and sports. The
CAPA was scored on a 4 point format (one to four) using a “structured-alternative” [57]
19
approach. Children were presented with two opposing choices and asked to decide
which statement best reflected their own feelings. This format was used as a means of
reducing “social desirability” tendencies that often occur in responses of children to
questionnaires. Once children made their choice, they then had select if it was
“somewhat true” or “really true”.
Body image was examined using Collins’ child figure drawings scale [58]. The scale
includes seven silhouette figures of boys and girls ranging from very thin to obese. The
children were asked to indicate the figure that best represented how they currently
looked (perceived) and how they wanted to look (ideal). Body dissatisfaction was the
difference between the perceived and ideal scores. Negative and positive scores
indicated a desire to be fatter or thinner respectively. Moderate to high test–retest
reliability and validity have been previously shown for the scale in children [59].
Self-esteem was measured using Rosenberg’s self-esteem scale [60]. The responses
to the 10 items were rated on a 4-point scale (strongly disagree to strongly agree),
yielding scores between 10 and 40, with higher scores indicating higher self-esteem.
This scale is the most widely used measure of global self-esteem and is valid and reliable
for students in third to eighth grades [61].
The self-perception profile for children [62] was also used to assess children’s perceived
self-competence. The scale is composed of five specific self-concept domains
(scholastic competence, athletic competence, social competence, physical appearance,
and behavioral conduct) and a separate global self-worth (or self-esteem) subscale.
There are a total of 36 items, six for each subscale. The response to each item is scored
from 1 to 4, where a score of 1 represents a low perceived competence and a score of
4 indicates a high perceived competence. The response scale is presented in a
structured alternative format in order to overcome the children’s tendency to give socially
desirable responses. For each statement the child is first asked to decide which kind of
kids he/she is most like, those described on the left or those described on the right. Once
having made this decision, the child next decides one of these options “really true for
me” or “sort of true for me”.
The pediatric quality of life inventory version 4.0 [63] was used to assess health-related
quality of life. It is based on a modular approach with generic and disease-specific
20
instruments. The generic core scales were specifically designed to measure the core
health dimensions outlined by the World Health Organization, covering physical,
emotional, social and school functioning. For children ages 8-18 years, items are rated
on a 5-point likert response scale, ranging from 0 (never) to 4 (almost always), to indicate
how much the child has problems with these areas of functioning. From these four core
scales, three summary scores can be calculated: a total quality of life score, a physical
health score, and a psychosocial health score (emotional, social, and school functioning
scales combined).
(7) Physical activity and dietary intake measures
Daily PA was measured using an ActiGraph accelerometer, model GT3X (Pensacola,
FL USA) at the baseline and at the conclusion of the study. This is a small, lightweight,
triaxial device. This accelerometer produces ‘‘raw’’ output in activity counts per minute
(cpm), which gives information about the total amount of physical activity [64]. The
accelerometer output can also be interpreted using specific count cut-points, which
categorizes activity counts as either sedentary, light, moderate, or vigorous PA. Data
reduction, cleaning, and analyses of accelerometer data were performed as described
elsewhere [65, 66]. For the present study, data were analyzed using specific cut-points,
which have been validated for children and adolescents: ≥2296 cpm for moderate to
vigorous PA [67]. In this study, the epoch duration was set to 5 seconds, which seems
to be more accurate and suitable concerning to the spontaneous and intermittent
activities of the young children [68]. The study was conducted on 7 consecutive days
(Monday to Sunday). A minimum of 10 hours per day was considered as valid data for
the analysis. Parents were instructed to attach the accelerometer when the child awoke
and to remove it when they went to bed. The accelerometer was firmly adjusted at the
child’s hip by an elastic waist belt under their school clothing. Activities were not
prescribed or directed by the teachers or researchers. All children participated in normal
activities with their classmates.
Dietary intake was assessed at the baseline and at the conclusion of the study from a
three-day dietary record, including two weekdays and one weekend day, completed by
parents. Foods portion size and beverages consumed were estimated using household
measures (cups, glasses, spoons, slices, food wrappers or containers etc.) as an aid in
determining serving sizes. A description of each food and beverage consumed was
recorded, including the method of preparation, the time (to the nearest 5 minutes),
21
location and if appropriate the brand name of the product. The nutrient analysis was
performed using the software Food Processor SQL (ESHA Research Inc., Salem, OR,
US). This program uses nutritional information from the United States that has been
adapted for use with typical Portuguese foods and beverages. Nutrient means of the
three days was used in the analysis. At enrollment all children had a meeting with a
nutritionist where appropriate food choices were discussed such as the reduction intake
of energy dense foods by substituting by healthier alternatives and the increase
consumption of fresh fruits and vegetables. Furthermore, one hour session in a small
group was led by a nutritionist about energy balance and healthy diet concepts.
Results achieved: Baseline data in all items of the study were collected.
Resources allocated to this task: materials related to secretarial work (questionnaires),
breakfast food (bread, ham, cheese, yogurt, and water), material and equipment to blood
analysis (specific kits conceived in specialized laboratories).
Date of task conclusion: September 8th, 2013
Activity 2 - Entering data, screening and statistical analysis
After data collection, it was entering data, screening and statistical analysis. Descriptive
statistics (means and standard deviations) were calculated for both groups at the
baseline. None of the anthropometric, body composition, CMRF, inflammatory markers,
cardiorespiratory fitness and psychological measures showed significant deviations from
a normal distribution (Kolmogorov-Smirnov normality test). Baseline differences in mean
anthropometric, body composition, CMRF, cardiorespiratory fitness and psychological
characteristics between groups were tested with one-way analysis of variance (ANOVA)
and chi-square tests (biological maturity status). Effect size was calculated using partial
eta-squared (η2) and interpreted as small (≥0.01), medium (≥0.06), or large (≥0.14) [49].
The significance level in all analyses was set at 0.05. Statistical analyses were
conducted using SPSS version 21.0.
An individual report including all test results and a brief interpretation were provided to
the children’s parents (see appendix).
22
Results achieved: at the end of this task it was obtained all the baseline information
needed, data entry, screening and statistical analysis.
Resources allocated to this task: Two graduate students in Sport Sciences, under the
guidance of the principal investigator were selected to punching and screening data.
Date of task conclusion: September 8th, 2013
Activity 3 - Randomization of the intervention groups
After completing the baseline measures, data entering, screening and statistical
analysis, ninety children were randomly assigned to different training groups: the first
group was designated has the soccer group (SG) (n=30); the second group has the
traditional physical activity group (TG) (n=30); and the third group comprised children
who were not interested to participate in any intervention and whose physical activities
were limited to those included in the compulsory physical education curriculum at school
and was defined as control group (CG) (n=30) (2 sessions per week, 45-90 min each).
Children were assigned to intervention groups on the basis of the day of the week in
which they have the possibility to attend the training sessions. Children who attended on
tuesday, thursday and saturday were assigned to the SG and those on monday,
wednesday and friday to the TG. Figure 1 provide a detailed schematic of the study
design and children flow.
23
Figure 1. Participant flow diagram.
Results achieved: randomization of the intervention groups.
Resources allocated to this task: Principal investigator.
Date of task conclusion: September 8th, 2013
3.3. TASK 3 - Soccer and individual intervention programs
Activity 1 - Soccer and traditional intervention programs
The soccer intervention program consisted of a warm-up (10-20 min), different technical
drills and small-sided games (40-60 min), and a cool-down (10 min). The detailed
contents and types of exercises of soccer intervention program is summarized in Table
6. The soccer intervention program was carried out at the facilities of the Faculty of Sport
- University of Porto three times a week (tuesday and thursday, 18:30-20:00 hours;
saturday, 10:00-11:30).
24
Table 6. Contents and types of exercises of soccer intervention program.
Contents
Types of Exercises
Tactical - Technical
Individual tasks
1st Phase - small sided games (1v0; 2v0;
Passing
3v0+Gk; 1v1+Gk)
Reception
Shooting
2nd Phase - attack v defense (2v1+Gk;
Dribbling
2v2+Gk; 3v2+Gk; 4v3+Gk; 6v5+Gk)
Intercept
Basic marking/ Open-up
3rd
Elementar Colective tasks
(Gr+3v3+Gr; Gk+4v4+Gr; Gk+6v6+Gk)
Phase
-
small
sided
games
Defensive and offensive principles
Combinations
Physical fitness
Aerobic
Games and drills with and without ball
Anaerobic
Muscular strength
Coordination
Agility
Flexibility
The traditional intervention program was multidimensional, since it was designed to
develop aerobic endurance, strength, flexibility, coordination and balance. In each
session we try to provide routines with activities and exercises as varied as possible, in
accordance with the recommendations of [12]. The physical activity program was also
designed to develop the enjoyment and body awareness, looking to long-term changes
in behavioural patterns. All sessions consisted of a generalized type of physical activity
that is usually offered to this age group and that include: a warm-up (10-20 min), different
kind of activities such as walking, running, gymnastics, and exercises to improve
coordination, flexibility, and strength training (40-60 min), and cool-down (10 min). The
traditional physical activity intervention program was carried out at the facilities of the
Faculty of Sport - University of Porto three times a week (monday, wednesday and friday,
18:30-20:00 hours).
The training intensities for both intervention programs were designed to keep the heart
rate (HR) > 70-80% of maximum heart rate as confirmed by heart rate monitoring (Polar
25
Team 2 Pro System, Polar Electro, Kempele, Finland). The training sessions were
conducted by two physical education teachers. Both intervention programs training
sessions were supervised by two graduates in Sport Sciences, under the guidance of
principal investigator. Both intervention programs were initiated on September 9th, 2013
and finished on March 9th 2014. In the first two weeks of March 2014 were held the final
assessments.
Children that composed the CG did not have any intervention and followed the
compulsory physical education curriculum at school (n=30) (2 sessions per week, 45-90
min each).
Results achieved: To conclude soccer and traditional intervention programs.
Resources allocated to this task: Two physical education teachers, under the guidance
of the principal investigator, supervised intervention programs training sessions.
Date of task conclusion: March 9th, 2014
3.4. TASK 4 - Post intervention data collection, entering data, screening and
statistical analysis
Activity 1 - Final data collection
Post intervention data collection was structured in the same manner as baseline
assessment.
Results achieved: Post intervention data in all items of the study were collected.
Resources allocated to this task: materials related to secretarial work (questionnaires),
breakfast food (bread, ham, cheese, yogurt, and water), material and equipment to blood
analysis (specific kits conceived in specialized laboratories).
Date of task conclusion: March 16th, 2014
26
Activity 2 - Entering data, screening and statistical analysis
After post intervention data collection, we started data entry, screening and statistical
analysis. Descriptive statistics (means and standard deviations) were calculated for both
groups at the conclusion of the study. None of the anthropometric, body composition,
CMRF, inflammatory markers, cardiorespiratory fitness and perceived psychological
measures showed significant deviations from a normal distribution (KolmogorovSmirnov normality test). The intervention effects were evaluated with, a repeated
measures analysis of variance (ANOVA). For each characteristic, percentage of change
(%Δ) between baseline and after 6-months was also calculated; the difference was then
divided by baseline value. Pearson correlation coefficients were calculated to examine
which CMRF and inflammatory markers were associated with BMI z-score, percentage
of body fat and WtHR at the baseline and at the conclusion of the study. The significance
level in all analyses was set at 0.05. Statistical analyses were conducted using SPSS
version 21.0.
Results achieved: at the end of this task it was obtained all the post intervention
information needed, data entry and statistical analysis. For financial reasons three
inflammatory and oxidative markers (grelin, IL-6 and TBARS) were not determined.
However, many others, such as oxLDL, CPR, leptin, resistin, adiponectin and TNF-α
were determined.
Resources allocated to this task: Two graduate students in Sport Sciences, under the
guidance of the principal investigator were selected to data entry and screening data.
Date of task conclusion: March 24th, 2014
3.5. TASK 5 - Main Findings
Adherence
Of the 90 children participants in this project, 88 completed their assigned intervention.
Two children (one each in SG and TG) did not complete the study because of personal
reasons (SG) and lack of motivation (TG) (Figure 1). An average of 72 sessions were
conducted in each intervention group. Adherence measured by the number of sessions
attended during the intervention programs was higher >85% for both groups. The
27
average training durations and heart rate (HR) were similar between the SG (84.4±6.5
min/session; 156.3±6.4 bpm, ≈ 78%HRmax) and TG (80.1±8.3 minutes; 155.3±7.8 bpm,
≈ 75%HRmax).
Baseline differences
There were no significant differences between groups for baseline variables (p>0.05)
(Table 7).
Table 7. Baseline characteristics of participants by intervention assignment.
Intervention
Variables
SG
TG
10.5 (1.5)
10.7 (1.2)
CG
p value
Effect size
0.110
0.079
0.505
0.094
Anthropometry/body composition
Age (years)
10.0 (1.3)
Maturity status
PH1
14
7
12
PH2
11
12
12
PH3
3
7
4
PH4
1
3
2
Height (cm)
147.5 (11.9)
148.0 (9.2)
145.3 (9.3)
0.712
0.012
Weight (kg)
52.5 (13.6)
55.7 (9.8)
53.6 (14.2)
0.719
0.012
(kg/m2)
24.0 (2.8)
24.8 (3.4)
25.0 (3.8)
0.391
0.034
BMI z-score
2.4 (0.5)
2.5 (0.8)
2.7 (0.9)
0.264
0.048
Body fat (%)
34.3 (5.6)
38.3 (7.8)
35.9 (7.3)
0.110
0.079
Fat mass (kg)
18.3 (7.3)
21.5 (6.7)
18.8 (8.3)
0.384
0.035
Muscle mass (kg)
17.9 (4.7)
18.3 (4.1)
17.8 (4.8)
0.970
0.001
BMC (g)
31.4 (11.6)
29.3 (5.8)
29.1 (6.5)
0.679
0.016
BMD z-score
0.7 (1.4)
0.1 (1.0)
0.6 (1.1)
0.195
0.081
Waist circumference (cm)
83.6 (9.4)
89.6 (8.3)
85.7 (11.7)
0.169
0.064
WtHR
0.56 (0.04)
0.61 (0.06)
0.59 (0.06)
0.017
0.140
SBP (mm Hg)
111.0 (12.4)
109.9 (7.8)
109.1 (15.3)
0.908
0.004
DBP (mm Hg)
57.6 (8.6)
57.4 (7.8)
54.9 (10.3)
0.631
0.019
Insulin (mU/mL)
9.2 (4.3)
10.3 (5.6)
7.5 (3.3)
0.301
0.056
Glucose (mmol/L)
80.6 (5.5)
85.1 (4.8)
82.6 (7.0)
0.085
0.177
HOMA-IR
1.7 (0.9)
2.2 (1.3)
1.55 (0.7)
0.196
0.070
Triglycerides (mg/dl)
70.9 (31.8)
88.3 (55.2)
61.8 (26.5)
0.212
0.068
Total cholesterol (mg/dl)
171.6 (42.7)
161.3 (26.6)
166.4 (21.3)
0.704
0.015
HDL cholesterol (mg/dl)
53.6 (9.5)
49.2 (13.4)
49.7 (8.0)
0.401
0.040
LDL cholesterol (mg/dl)
104.3 (42.2)
94.5 (31.9)
104.3 (21.1)
0.665
0.018
BMI
Cardiometabolic risk factors
28
Inflammatory markers
oxLDL (U/L)
58.8 (25.2)
54.7 (16.2)
58.5 (18.9)
0.827
0.008
CRP (mg/L)
2.1 (2.3)
1.4 (1.3)
0.6 (0.4)
0.061
0.117
21.6 (16.1)
27.1 (21.0)
23.0 (20.5)
0.617
0.016
Resistin (ng/ml)
4.6 (1.5)
4.7 (1.2)
5.1 (1.3)
0.573
0.024
Adiponectin (µg/ml)
11.2 (4.9)
8.4 (3.4)
11.4 (3.9)
0.098
0.096
TNF-α (pg/ml)
0.25 (0.07)
0.22 (0.05)
0.25 (0.10)
0.408
0.038
Self-esteem
31.2 (4.7)
29.6 (4.7)
29.8 (5.8)
0.572
0.023
Attraction to PA
43.5 (5.3)
43.6 (5.2)
42.3 (5.9)
0.752
0.013
100.8 (13.8)
95.2 (13.1)
100.9 (13.8)
0.307
0.050
Body image
2.7 (1.1)
1.9 (1.1)
1.9 (0.8)
0.082
0.126
Quality of Life
2.8 (0.9)
2.8 (0.7)
2.8 (0.7)
0.963
0.001
Time VO2máx (min)
8.63 (2.43)
7.86 (2.50)
8.51 (2.67)
0.536
0.024
VO2max (ml/kg/min)
44.7 (8.5)
43.1 (8.7)
48.6 (11.5)
0.328
0.047
112.2 (52.9)
103.0 (52.1)
107.4 (41.1)
0.772
0.006
1701.1 (218.7)
1620.4 (195.0)
1712.8 (145.6)
0.131
0.047
Leptin (ng/ml)
Cardiorespiratory fitness
Perceived competence
Physical fitness
MVPA (min/day)
Energy intake (kcals/d)
SG, soccer group; TG, traditional group; CG, control group; WtHR, waist to height ratio; MVPA,
moderate to vigorous physical activity
Intervention effects on anthropometric characteristics, body composition, CMRF
and inflammatory markers, cardiorespiratory fitness and psychological status
Changes in anthropometric characteristics, body composition, CMRF and inflammatory
markers, cardiorespiratory fitness and psychological measures in each group are shown
in Tables 8 to 10.
Anthropometric characteristics and body composition

Children involved in physical activity intervention programs decreased
significantly their BMI z-score, fat mass, percentage of body fat, WC and WtHR
(p<0.05) and increase their muscle mass, BMC and BMD z-score (p<0.05).

Children participants in the CG only showed a significant improve in muscle mass
and BMC between baseline and the end of the study (p<0.05). In contrast, a
significant increase in fat mass and percentage of body fat was observed
(p<0.05).
29
CMRF and inflammatory markers

SG showed appreciable decreases in total cholesterol, HDL cholesterol, LDL
cholesterol, and DBP (p<0.05).

Triglycerides decreased significantly in the two groups involved in sport activities
(p<0.05).

Changes in SBP, glucose levels, insulin and HOMA-IR were not significantly
different between groups (p>0.05).

Leptin decreased significantly in the two groups involved in sport activities
(p<0.05).

Resistin and oxLDL decreased significantly in the SG (p<0.05).

Adiponectin concentrations improved in both groups (p<0.05), with a greater
increase in the two groups involved in sport activities (SG: 23.6%; TG: 19.4%).

Circulating concentrations of CRP decreased in children in both intervention
groups (p>0.05).
Psychological measures and cardiorespiratory fitness

Significant greater changes was observed in perceived psychological status in
both intervention groups compared to CG.

Children involved in physical activity intervention programs improved their body
image, self-esteem, and quality of life, perceived themselves as more successful
and physically competent, and were more attracted to participate in PA (p<0.05).
30
Association between CMRF and inflammatory markers and BMI z-score,
percentage of body fat and WtHR
The association between CMRF and inflammatory markers and BMI z-score, percentage
of body fat and WtHR in each group are shown in Tables 11 to 13.

Leptin concentrations were significantly associated with BMI z-score, percentage
of body fat and WtHR in both groups at the conclusion of the study (p<0.05).

CRP was positively associated with percentage of body fat in both groups at the
conclusion of the study (p<0.05).

Adiponectin was negatively associated with BMI z-score, percentage of body fat
and WtHR in children participants in the CG at the conclusion of the study
(p<0.05).

oxLDL was positively associated with BMI z-score and WtHR in children
participants in the CG (p<0.05).
31
Table 8. Changes in anthropometric characteristics and body composition of participants by intervention assignment.
Soccer group
Traditional group
Control group
Repeated measures ANOVA
Post
%Δ*
Post
%Δ*
Post
%Δ*
Height (cm)
148.0 (12.1)
0.8
151.1 (8.7)
1.3
146.9 (9.4)
1.1
0.531 <0.001
0.074
Weight (kg)
52.1 (13.6)
0.6
57.2 (7.6)
0.6
55.5 (14.5)
3.4
0.430
0.010
0.052
BMI (kg/m )
23.4 (2.6)
-1.1
25.1 (3.3)
-0.5
25.3 (4.3)
0.6
0.169
0.958
0.531
BMI z-score
2.2 (0.5)
-8.7*
2.3 (0.8)
-14.3*
2.7 (0.9)
-5.5
0.164 <0.001
0.238
Body fat (%)
32.4 (5.4)
-7.4*
34.2 (10.4)
-17.2*
37.6 (10.5)
5.7*
0.363
0.046
<0.001
Fat mass (kg)
17.4 (6.7)
-5.6
19.7 (7.4)
-17.3*
22.5 (10.4)
9.3*
0.263
0.680
<0.001
Muscle mass (kg)
19.1 (4.8)
7.3*
20.5 (4.2)
8.6*
19.4 (5.1)
5.7*
0.717 <0.001
0.160
BMC (g)
32.7 (13.6)
5.5*
32.7 (7.3)
7.3*
29.0 (4.7)
3.9*
0.529 <0.001
0.060
BMD z-score
0.8 (1.3)
12.5
0.3 (0.9)
66.6
0.5 (1.1)
-20.0
0.275
0.227
0.009
WC (cm)
79.7 (9.5)
-5.3*
86.0 (7.7)
-5.2*
85.5 (12.3)
-0.5
0.078 <0.001
0.001
WtHR
0.53 (0.54)
-4.2*
0.57 (0.06)
-7.5*
0.58 (0.07)
-1.6
0.039 <0.001
0.002
Variables
2
G
T
Maturity status†
PH1
9
5
8
PH2
14
8
15
PH3
4
12
5
PH4
2
3
2
*significant different from baseline (p<0.05); †p=0.200; G, group effect; T, time effect; G*T, interaction effect; WtHR, waist to height ratio
32
G*T
Table 9. Changes in CMRF and inflammatory markers of participants by intervention assignment.
Soccer group
Traditional group
Control group
Repeated measures ANOVA
Post
%Δ*
Post
%Δ*
Post
%Δ*
G
T
G*T
SBP (mm Hg)
111.4 (10.6)
-0.2
114.8 (12.3)
3.1
110.5 (8.9)
-0.6
0.897
0.420
0.425
DBP (mm Hg)
53.7 (7.5)
-9.2*
52.6 (7.9)
-8.5
56.7 (6.2)
0.8
0.693
0.108
0.309
Insulin (mU/mL)
8.3 (3.8)
-7.8
10.3 (4.6)
-9.8
9.5 (3.8)
15.3
0.307
0.629
0.297
Glucose (mmol/L)
83.4 (8.1)
3.3
88.1 (7.6)
2.3
82.5 (5.3)
-0.1
0.020
0.073
0.389
HOMA-IR
2.0 (1.0)
-19.4
2.2 (0.9)
-8.6
1.6 (0.7)
14.8
0.242
0.207
0.680
Triglycerides (mg/dl)
54.9 (15.9)
-28.9*
65.3 (25.9)
-33.7*
74.0 (44.6)
0.8
0.406
0.086
0.026
Total cholesterol (mg/dl)
159.6 (32.1)
-7.2*
152.9 (31.2)
-5.9
173.1 (25.3)
3.4
0.573
0.096
0.022
HDL cholesterol (mg/dl)
57.7 (12.1)
5.7*
51.7 (13.7)
3.4
52.0 (8.7)
3.7
0.277
0.013
0.764
LDL cholesterol (mg/dl)
90.9 (32.3)
-14.3*
88.1 (29.6)
-10.8
106.3 (27.2)
0.3
0.519
0.029
0.067
oxLDL (U/L)
51.4 (18.4)
-12.4*
51.8 (17.1)
-7.2
60.0 (18.4)
1.9
0.703
0.018
0.014
CRP (mg/dl)
1.5 (1.7)
-132.4*
2.5 (4.5)
-19.3
0.7 (0.4)
2.4
0.125
0.682
0.251
16.1 (13.3)
-60.0*
20.9 (19.8)
-66.9*
23.4 (19.3)
-11.4
0.620
0.039
0.300
Resistin (ng/ml)
4.2 (1.2)
-8.5*
4.6 (1.2)
-4.5
5.4 (1.3)
3.5
0.178
0.544
0.111
Adiponectin (µg/ml)
15.0 (6.8)
23.6*
11.3 (4.8)
19.4*
14.0 (5.4)
16.9*
0.135
<0.001
0.463
TNF-α (pg/ml)
0.28 (0.12)
14.6
0.27 (0.07)
27.5
0.33 (0.14)
46.8*
0.290
0.003
0.380
Variables
CMRF
Inflammatory markers
Leptin (ng/ml)
*significant different from baseline (p<0.05); G, group effect; T, time effect; G*T, interaction effect.
33
Table 10. Changes in psychological measures and cardiorespiratory fitness of participants by intervention assignment.
Soccer group
Traditional group
Control group
Repeated measures ANOVA
Post
%Δ*
Post
%Δ*
Post
%Δ*
G
T
G*T
Self-esteem
34.0 (4.4)
6.7*
33.2 (5.1)
9.7*
26.6 (6.8)
-14.8
0.015
0.167
0.019
Body image
1.7 (1.4)
1.4*
1.2 (0.8)
0.9*
1.5 (1.2)
0.4
0.185
<0.001
0.392
109.4 (11.7)
7.3*
102.8 (18.3)
5.8*
95.0 (19.6)
-7.1
0.264
0.054
0.014
Attraction to PA
47.4 (3.8)
8.2*
46.6 (4.8)
6.2*
40.9 (8.5)
-6.8
0.061
0.005
0.057
Quality of life
3.2 (0.5)
10.1*
3.2 (0.6)
10.3*
2.9 (0.8)
2.7
0.660
0.007
0.438
Time VO2máx (min)
10.11 (2.22)
14.0*
9.34 (2.05)
16.0*
8.52 (3.29)
-4.0
0.485
<0.001
0.062
VO2max (ml/kg/min)
50.4 (5.6)
11.6*
48.1 (8.4)
9.7*
50.7 (13.9)
1.6
0.474
<0.001
0.385
114.8 (48.7)
3.3
105.7 (51.4)
3.2
108.1 (40.3)
1.0
0.761
0.061
0.666
1647.9 (259.2)
-4.3
1622.9 (223.0)
-0.3
1682.1 (164.9)
-2.5
0.296
0.098
0.377
Variables
Psychological measures
Perceived competence
Cardiorespiratory fitness
MVPA (min/day)
Energy intake (kcals/d)
*significant different from baseline (p<0.05); G, group effect; T, time effect; G*T, interaction effect.
34
Table 11. Association between BMI z-score and CMRF and inflammatory markers of participants by intervention assignment.
Soccer group
Traditional group
Control group
Explanatory variable
Baseline
Post
Baseline
Post
Baseline
Post
SBP (mm Hg)
0.06
0.24
0.38
0.38
0.28
0.23
DBP (mm Hg)
-0.13
0.14
0.29
0.25
-0.14
0.01
Insulin (mU/mL)
-0.07
0.06
-0.22
0.67*
0.32
0.62*
Glucose (mmol/L)
-0.19
0.32
-0.19
-0.18
0.45
0.35
HOMA-IR
-0.19
0.35
-0.24
0.64*
0.34
0.64*
Triglycerides (mg/dl)
0.22
0.33
0.17
0.52*
0.36
0.24
Total cholesterol (mg/dl)
0.03
-0.12
-0.37
-0.16
0.34
0.72*
HDL cholesterol (mg/dl)
0.15
-0.04
-0.10
-0.37
-0.39
-0.23
LDL cholesterol (mg/dl)
-0.03
-0.13
-0.43
-0.09
0.40
0.67*
oxLDL (U/L)
-0.20
-0.38
-0.27
-0.02
0.66*
0.75*
CRP (mg/dl)
0.45*
-0.02
0.72*
0.37
0.76*
0.41
Leptin (ng/ml)
0.52*
0.61*
0.87*
0.82*
0.34
0.65*
Resistin (ng/ml)
0.49*
0.51*
0.23
0.27
-0.09
-0.03
Adiponectin (µg/ml)
-0.22
-0.31
0.45
0.27
-0.50
-0.58*
TNF-α (pg/ml)
-0.06
-0.08
-0.43
0.01
0.21
0.06
*p<0.05
35
Table 12. Association between percentage of body fat and CMRF and inflammatory markers of participants by intervention assignment.
Soccer group
Traditional group
Control group
Explanatory variable
Baseline
Post
Baseline
Post
Baseline
Post
SBP (mm Hg)
0.37
0.22
0.28
0.33
0.30
0.41
DBP (mm Hg)
0.26
0.29
0.40
0.34
-0.07
0.34
Insulin (mU/mL)
0.36
0.03
-0.29
0.61*
0.32
0.25
Glucose (mmol/L)
-0.32
0.33
-0.15
-0.03
0.14
0.32
HOMA-IR
0.18
0.15
-0.31
0.60*
0.29
0.28
Triglycerides (mg/dl)
0.26
0.22
0.28
0.58*
0.58
0.16
Total cholesterol (mg/dl)
-0.03
-0.15
-0.21
0.07
0.56
0.50
HDL cholesterol (mg/dl)
0.08
0.09
-0.09
-0.38
-0.50
-0.15
LDL cholesterol (mg/dl)
-0.07
-0.20
-0.30
0.15
0.61*
0.46
oxLDL (U/L)
-0.19
-0.44*
-0.02
0.27
0.73*
0.42
CRP (mg/dl)
0.69*
0.45*
0.84*
0.61*
0.54
0.86*
Leptin (ng/ml)
0.68*
0.64*
0.75*
0.76*
0.64*
0.70*
Resistin (ng/ml)
0.45*
0.31
0.16
0.19
-0.01
0.09
Adiponectin (µg/ml)
-0.13
-0.16
0.37
0.23
-0.40
-0.62*
TNF-α (pg/ml)
-0.13
-0.15
-0.51
-0.05
0.43
0.12
*p<0.05
36
Table 13. Association between WtHR and CMRF and inflammatory markers of participants by intervention assignment.
Soccer group
Traditional group
Control group
Explanatory variable
Baseline
Post
Baseline
Post
Baseline
Post
SBP (mm Hg)
0.38
0.38
0.47
0.26
0.20
0.09
DBP (mm Hg)
-0.02
0.18
0.51*
0.24
-0.02
-0.09
Insulin (mU/mL)
0.24
0.07
-0.28
0.49
0.57
0.40
Glucose (mmol/L)
-0.22
0.37
-0.29
-0.14
0.30
0.03
HOMA-IR
-0.03
0.43
-0.31
0.47
0.56
0.38
Triglycerides (mg/dl)
0.47*
0.24
0.21
0.52*
0.60*
0.31
Total cholesterol (mg/dl)
-0.06
-0.19
-0.25
-0.01
0.51
0.79*
HDL cholesterol (mg/dl)
0.17
-0.03
-0.13
-0.39
-0.66*
-0.63*
LDL cholesterol (mg/dl)
-0.14
-0.21
-0.30
0.08
0.61*
0.84*
oxLDL (U/L)
-0.22
-0.33
-0.01
0.11
0.67*
0.80*
CRP (mg/dl)
0.75
0.31
0.82*
0.43
0.55
0.48
Leptin (ng/ml)
0.54*
0.68*
0.68*
0.72*
0.46
0.84*
Resistin (ng/ml)
0.56*
0.35
0.30
0.17
-0.13
0.21
Adiponectin (µg/ml)
-0.16
-0.31
0.33
0.19
-0.42
-0.62*
TNF-α (pg/ml)
-0.17
-0.25
-0.44
-0.12
0.44
0.09
*p<0.05
37
3.6. Dissemination of the present project in Portuguese community
University of Porto
http://noticias.up.pt/pessoas_da_up/andre-seabra/#.UeRNphn2uZ4.facebook
Jornal de Notícias (newspaper)
http://ciafel.fade.up.pt/files_download/uefa_ciafel.pdf
EXPRESSO (newspaper)
http://expresso.sapo.pt/uefa-financia-estudo-da-universidade-do-porto=f816953
A BOLA TV
http://www.youtube.com/watch?v=E2MPntL3BTg
Record (newspaper)
http://www.record.xl.pt/Futebol/interior.aspx?content_id=829043
University of Minho
http://umonline.uminho.pt/ModuleLeft.aspx?mdl=~/Modules/Clipping/NoticiaVie
w.ascx&ItemID=94992&Mid=111&lang=pt-PT&pageid=1&tabid=0
CUF Hospital
http://www.desportocuf.pt/DestaqueDetalhe/HCP_UEFA%20financia%20project
o
Boas Notícias (online newspaper)
http://boasnoticias.sapo.pt/noticias_UPorto-Futebol-no-combate-%C3%A0obesidade-intantil_16294.html?page=0
RTP (Portuguese Radio Television)
http://www.youtube.com/watch?v=s7RBbFbzOxM
38
Given the enormous interest that the Portuguese public opinion and academic
community has shown with regard to this project, we will organize on 4 to 5 of
June 2014 an international conference on “Soccer as a strategy to promote health
and quality of life”. The idea is to inform and discuss that Soccer can be an
important strategy for promoting health and quality of life, regardless of nutritional
status, age, sex, socio-economic status and ethnicity of their participants.
In addition to the presentations of the team members associated with this project,
other Portuguese and International academic researchers and personalities
related with soccer were also invited to present a communication. It would be a
great honor for us to have the UEFA participation in this conference with the
presentation of a lecture on a topic related to Soccer and Health. As soon as
possible we send you a preliminary program of this conference.
Conference date: June 4th and 5th, 2014
V. CONCLUSIONS
Childhood obesity is associated with several adverse physical, cardiometabolic
and psychological health consequences [69, 70]. The potential of physical activity
interventions to alleviate the burden of obesity and to improve the weight status,
body composition and cardiometabolic and perceived psychological status of
obese children is thus significant to public health.
The present study was
designed in this context and specifically examined the effects of a 6-month
recreational
soccer
cardiometabolic
intervention
risk factors
program
(CMRF),
on
the
inflammatory
body
composition,
markers,
perceived
psychological status and cardiorespiratory fitness (CRF) of obese children.
The first research hypothesis addressed in the study was the following:
“Systematic practice of recreational soccer has a significant effect in reducing
CMRF and percentage of body fat, and in improving muscle and bone mass,
cardiorespiratory fitness and associated psychological consequences”.
39
The 6-month recreational soccer intervention program (60-90 min, three times
per week, intensity >70-80% HRmax) resulted in beneficial changes in body
composition, CMRF, inflammatory markers, perceived psychological status and
CRF of obese children.
The soccer intervention program showed a positive effect on all parameters of
body composition and nutritional status. After the 6-month intervention,
participants in the soccer intervention experienced significant reduction in
percentage of body fat (-7.4%), and improvement in muscle (+7.3%) and bone
mass (+5.5%), with negligible change in BMI (-1.1%). In addition, WC (-5.3%)
and WtHR (-4.2%) declined. The latter indicators are highly predictive for CMRF
[71]. There is strong evidence that beneficial effects on muscle and bone mass
may be achieved by promoting participation in high impact sports, which impose
high levels of muscular contractions and submit the growing skeleton to frequent
mechanical stresses and strains [72-74]. Soccer is an activity that activates a
wide range of the body’s musculature to meet the physical demands of the game,
such as numerous changes of the speed running, kicking the ball and body
contacts [75]. Further, since soccer involves a high number of jumps and other
movements requiring abrupt changes of the position of the body center of mass,
it can be considered a weight-bearing sport [75]. Results of the present study
reinforce these concepts and highlight the positive contribution of soccer to
augment muscle (+7.3%) and bone (+5.5%) mass.
Beneficial effects of regular physical activity on CMRF, inflammatory markers and
CRF are well-established in obese children and adolescents [7, 28, 32, 33]. Most
of the studies have used traditional endurance activities (walking, jogging or
bicycling) and occasionally group activities. To our knowledge, no studies have
addressed the effects of an intense intermittent soccer intervention on CMRF,
inflammatory markers and CRF in obese children. Findings of the present study
indicated significant improvements in CMRF (-28.9% to 5.7%) and inflammatory
markers (-132.4% to 23.6%) and also CRF (+11.6%) over the course of the
soccer intervention program.
The soccer intervention program was also associated with beneficial changes in
psychological status in obese children. SG participants experienced significant
improvements in body image, self-esteem, attraction to participate in PA,
40
perceived physical competence and quality of life. The results were consistent
with other studies highlighting the importance of physical activity in enhancing
perceived psychological status of obese children [8, 79]. The present findings
thus suggested that participation in soccer was an effective strategy to reverse
and perhaps enhance perceived psychological status associated with obesity in
late childhood/early adolescence (8-12 years). The results also suggested an
increase in the likelihood of the adoption and maintenance of physical activity
among the soccer participants [80]. In addition to these aspects is important to
note that soccer is the most popular and preferred sport at all ages and across
social and economic strata of the population [81]. Since soccer is a relatively
inexpensive, accessible, and easy sport to learn, it may offer obese children
opportunities for enjoyable physical activity that has potential psychological
benefits. As a team-based activity, soccer probably has more chances to
enhance perceived psychological status of participants than many individual
physical activities. The team/group format includes teammates (peers) who
provide encouragement and also who serve as a buffer when things break down
during game play. In contrast, it is suggested that participation in most forms of
individual activities/sports provides limited interactions with other youth.
Individual activities also encourage the development of a strong sense of mastery
or individual accomplishment whereas team sports provide a fertile ground for
self-esteem enhancement associated with the group nature of the activities.
Team activities also provide opportunities for children to engage with peers and
adults in an effort to achieve collective goals (39). Other research has also noted
that children involved in team sports reported greater body satisfaction than
children participating in individual activities (40). Since team activities/sports
focus on the group in contrast to the individual, they may provide a buffer to
individual social evaluation as the focus is on the group. Individual
activities/sports,
in
contrast,
offer
more
opportunities
for
one-on-one
comparisons, which may heighten levels of body dissatisfaction (40). Thus,
soccer appear to have the potential to promote teamwork and sharing, and
provide opportunities to enhance attraction to participate in physical activity, selfesteem, self- and body-satisfaction, perceived physical competence and quality
of life.
In summary, the soccer intervention resulted in significant improvements in body
composition, CMRF and cardiorespiratory fitness and perceived psychological
41
status of obese children. Soccer as a highly popular sport, socially and culturally
meaningful and accessible to all social strata thus has potential to operate as a
highly effective tool for the prevention and reduction of childhood obesity and
associated consequences for health and fitness.
The second research hypothesis addressed in the study was the following:
“Systematic practice of recreational soccer has a greater effect than other
traditional
physical
activity
intervention
program
in
increasing
energy
expenditure, reducing CMRF, and improving body composition, cardiorespiratory
fitness and associated psychological consequences”.
To our knowledge, this study may be the first which compared a soccer
intervention (SG) with a traditional physical activity program (TG) and a control
group (CG). The three groups did not differ in lipid profile, markers of glucose
metabolism, inflammatory markers, CRF, and indicators of psychological status
at baseline.
After the 6-month intervention period, CG showed significant changes in body
composition, specifically an increase in body fat, fat mass, muscle mass and
BMC, but no significant changes in lipid profile. Rather, the trend in means
suggested a worsening of the lipid profile (except for HDLc), inflammatory
markers (increased CRP and TNF-α), oxidative stress (higher oxLDL) and
glucose metabolism (increased insulin, HOMA-IR, resistin; decreased leptin). In
contrast this pattern was almost reversed in SG and TG who presented a general
improvement in the body composition and CMRF profile compared to the CG.
This improvement, however, was more apparent in SG than TG.
Obese and sedentary individuals often present a more atherogenic lipid profile
than non-obese and physical active individuals. In the present study, physical
activity, as in SG and TG, was associated with improvements in plasma lipids
(reduced TC, LDL-c, oxLDL; increased HDL-c) and reductions in triglycerides.
The results for oxLDL are of particular relevance, as oxidized LDL particles play
a major role in the formation of atherosclerotic plaques. The reduction in oxLDL
and triglycerides together with an increase in HDL-c is associated with a slowing
of the atherogenic process.
42
Obesity is often described as a state of chronic low grade inflammation,
characterized by an increase in pro-inflammatory mediators and a reduction in
anti-inflammatory defenses. SG and TG both presented a decrease in the proinflammatory mediator leptin, a marker of adiposity and insulin resistance, and an
increase in adiponectin, an anti-inflammatory mediator associated with positive
changes in insulin sensitivity, lipid profile and oxidative stress. Both groups also
showed a reduction (only statistically significant in the SG) in the acute-phase
protein CRP, a sensitive marker of inflammation and of cardiovascular risk. SG
group also showed a reduction in resistin, a mediator traditionally linked to insulin
resistance.
Insulin resistance is a major issue in obesity, and is associated with dyslipidemia
and increased inflammation and oxidative stress. Although changes in markers
of glucose metabolism (glucose, insulin and HOMA-IR) were not significant, the
data suggested an increase in insulin sensitivity (reduction in insulin and HOMAIR) in both SG and TG in contrast to CG. The improvement in insulin resistance
is consistent with the observed increase in adiponectin and the reduction in leptin
and resistin. These results may have contributed to the favorable changes
observed in the lipid profile.
The present study showed that both physical activity interventions (SG and TG)
were effective in improving cardiorespiratory fitness and psychological status.
Significant improvements in VO2max occurred in both intervention groups.
Participants in the SG experienced an 11.6% improvement in VO2max and a 1.4
to 10.1% improvement in their psychological status whereas participants in the
TG group experienced a 9.7% and a 0.9 to 10.3% improvement in both the VO2max
and psychological status. Evidence suggests that lower cardiorespiratory fitness
has been associated to an increase in CVD risk markers, CVD morbidity and
mortality. To oppose this evidence, international health organizations suggest
that children should accumulate at least 60 minutes or more of aerobic MVPA per
day [12]. The recommendations also specify that the MVPA should be
developmentally appropriate and enjoyable, and should include a variety of
activities. Although the duration of the both intervention programs implemented
in the present study (60-90 min, 3 times/week) were less than current
recommendations, it seems that the intensity (average intensity >70-80%HRmax)
were appropriate to induce significant improvements in cardiorespiratory fitness.
43
It is important to note that obese children complied well with the both intervention
programs, resulting in high attendance rates (>85%). For all these reasons,
present study demonstrates the potential of both interventions as a means of
improving cardiorespiratory fitness and psychological status in obese children.
However, given that soccer is a highly popular sport, relatively inexpensive,
accessible, and easy to learn may be a better mode of exercise for obese children
of this age group.
In summary, the two physical activity intervention groups (SG and TG) showed
improvements
in
lipid
profile,
insulin
sensitivity,
inflammatory
status,
cardiorespiratory fitness and psychological status compared to the control group
(CG). The improvement in some variables was more apparent in SG than TG.
The third research hypothesis addressed in the study was the following: “With
recreational soccer as the template for regular physical activity or reducing the
expression of CMRF, new subsets of markers with greater sensitivity and
predictive and clinical utility will be developed”.
Cardiovascular morbidity and mortality of obesity is associated with classic risk
factors, namely dyslipidemia, hypertension and impaired glucose metabolism
[22]. However, classical markers may not be sufficiently sensitive at pediatric
ages and highlight a need to consider other markers of CMRF. Recent research
suggested the existence of other biological markers associated with proinflammatory and pro-oxidant states which are expressed at earlier ages with
greater sensitivity [24, 25]. These novel markers are adiponectin and its isoforms,
leptin, resistin, high sensitivity C- reactive protein (CRP), tumor necrosis factor
alpha (TNF-α) and lipoprotein particularly its oxidized high-density (LDL-ox).
Previous studies examining the association between CMRF and obesity and
body composition components in children have reported conflicting results.
However, some of them have reported positive or negative associations and
others have reported no associations. The results of the present study showed a
significant and positive association between leptin concentrations and BMI zscore, percentage of body fat and WtHR. High levels of leptin were associated
with an increase in obesity and percentage of body fat in obese children. Leptin
44
acts in the hypothalamus and helps to control energy intake and expenditure in
lean individuals. In obese, however, a state of resistance to leptin actions (similar
to what occurs for insulin) appears, leading to an increase in its circulating levels
[83]. The absence of leptin increases appetite and decreases energy
expenditure, leading to obesity. Many previous studies have discussed the
effects of regular physical activity on leptin concentrations [84-85], but uncertainty
remains as to how circulating leptin reacts to exercise training since previous
studies have produced inconsistent results. However, the results of the current
study showed a 60 to 66.9% decrease in leptin levels among children who
participated in physical activity intervention programs suggesting that obese
children can decrease leptin production and secretion in response to physical
activity participation and subsequent changes in body composition.
Another important finding was the inverse association between adiponectin levels
and BMI z-score, percentage of body fat and WtHR that was observed in the CG
participants at the conclusion of the study. Lower levels of plasma adiponectin
were significantly associated with obesity and body composition components in
the obese CG participants. Adiponectin is an adipocytokine with multiple positive
effects on metabolism, such as regulation of satiety carbohydrate and lipid
metabolism, increasing insulin sensitivity and reducing oxidative stress,
inflammation, atherogenesis and vascular remodeling [26]. Obesity increases the
production of adipocytokines that cause insulin resistance but decreases the
production of adiponectin, which reduces insulin resistance [82]. Previous studies
examining the effects of exercise training on adiponectin levels have also
reported conflicting results
Although previous studies have shown that adiponectin levels seems to be
already reduced in young obese subjects the effects of physical activity in their
production and secretion have reported conflicting results. The present study
demonstrated that physical activity induce significant improvements in
adiponectin levels among obese children.
In summary, although more studies are needed to understand the association
between CMRF and inflammatory markers and obesity, the use of leptin and
adiponectin in routines clinical analyses could help to identify children with
increased risk of obesity and obesity-associated comorbidities.
45
The TAKE HOME MESSAGE of the present study was the following:
“Soccer as a highly popular socially and culturally meaningful sport
accessible to all social strata is a highly effective medium for the
prevention/reduction of childhood obesity and for the enhancement of body
composition,
cardiometabolic
health,
cardiorespiratory
fitness
and
associated psychological status of obese youth”.
V. REFERENCES
1. Rolland-Cachera, M.F., Childhood obesity: current definitions and recommendations
for their use. International Journal of Pediatric Obesity, 2011. 6(5‐6): p. 325-331.
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44. Van Der Heijden, G.-j., et al., Strength exercise improves muscle mass and hepatic
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48
45. Watts, K., et al., Exercise training normalizes vascular dysfunction and improves
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Top of Form
51
Appendix 1: Children questionnaire
FUTEBOL É SAÚDE
PROJECTO UEFA
DATA AVALIAÇÃO: _______________________
NOME: ___________________________________________________________________________
DATA DE NASCIMENTO: _____________________
TANNER 1: A
P
M
SEXO: M( ) F ( )
PESO:____________ ALTURA: _____________ ALTURA SENTADO: ____________
P Cintura: _________________________
P Anca: _________________
TAS 1: ____________ TAD 1: _____________ FC 1: _____________ MAP:______________
TAS 2 : ___________ TAD 2: _____________ FC 2: _____________ MAP:______________
(TAS 3 : ___________ TAD 3: _____________ FC 3: ______________ MAP:_____________)
(TAS 4 : ___________ TAD 4: _____________ FC 4: ______________ MAP:_____________)
Lista de verificação
Idade, Peso, Altura, Altura Sentado
Perímetro Cintura e Anca
InBody
Tanner
Tensão arterial (2 vezes sem diferença de 2mmHg)
Sangue
DEXA
KTK
VO 2 máx
Questionários
Este 2 questionários enquadram-se no Projeto “Futebol é Saúde”, no
qual o seu filho/a está a participar.
Estimamos que, na sua totalidade, demore cerca de 20 minutos a ser
preenchido.
Obrigada pela atenção dispensada.
Quem preencheu o questionário:
 Mãe
 Pai
 Outro: _____________________
CARACTERÍSTICAS DO SEU/SUA FILHO/A:
Data de Nascimento |___|___|.|___|___|.|___|___|___|___|
dia
mês
ano
A que horas se deita:
A que horas se levanta:
Em média, num dia normal de
semana
|___|___|Horas |___|___|Min
|___|___|Horas |___|___|Min
Em média, num dia de fim-desemana
|___|___|Horas |___|___|Min
|___|___|Horas |___|___|Min
Em média, quanto tempo é que o seu filho passa a ver TV, jogar videojogos
e no computador?(some todos os momentos)
Num dia normal de semana
 <30min
 30 min
 1h
 2h
 3h
 >3h
Num dia de fim de semana
 <30min
 30 min
 1h
 2h
 3h
 >3h
De acordo com o Boletim de Saúde: (se preferir pode anexar uma fotocopia da página 2 e 3 do Boletim de Saúde Infantil e
Peso
Juvenil do seu filho(a))
Comprimento/Altura
à Nascença
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
1 ano
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
2 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
3 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
4 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
5 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
6 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
7 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
8 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
9 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
10 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
Pratica Atividade Física organizada fora da escola?
 Sim
 Não
Se Sim, qual/quais:
Tipo de Atividade
Exemplo:
Karaté
Nº de vezes por semana
Duração de cada sessão
1x
2x
3x
4x
5x
6x
7x
30`
45`
1h
1h30
1x
2x
3x
4x
5x
6x
7x
30`
45`
1h
1h30
1x
2x
3x
4x
5x
6x
7x
30`
45`
1h
1h30
1x
2x
3x
4x
5x
6x 7x
30`
45`
1h
1h30
Dia(s) da semana
Segunda e Sexta
Qual o transporte que utiliza para ir para a escola?
 carro
 autocarro
 mota
 a pé
 Outro:__________________
quanto tempo demora no percurso casa-escola? _____________ minutos
-1 -
Qual o seu tipo de habitação:
 apartamento
 moradia
 Outro:__________________________________
No local onde vive, é possível que o seu filho brinque no exterior?  SIM
Se Sim, onde?  na rua
 num parque junto à sua casa
Se não, qual o motivo?  não tem quintal/jardim em casa
 no quintal/jardim de casa
 a rua tem muito tráfego
 a rua é perigosa em termos criminais,
o meu/minha filho/a é naturalmente muito
ativo
o meu/minha filho/a precisa de mim para ter
motivação para brincar
o meu/minha precisa de companhia (amigos,
Irmãos, pais) para ter motivação para brincar
 NÃO
 no parque infantil
 não há parque infantil
Outro: ______________________________
NUNCA
RARAMENTE
OCASIONALMENTE
FREQUENTEMENTE
SEMPRE















Comparando com crianças da mesma idade, considera o seu/sua filho/a:
 MUITO MAIS ACTIVO
 MAIS ACTIVO
 IGUAL
 MENOS ACTIVO
 MUITO MENOS ACTIVO
O/A seu/sua filho/a com quem vive:  PAI  MÃE  IRMÃOS  AVÓ  AVÔ  OUTROS: _________________
Quantas horas por dia, o/a seu/sua filho/a passa na escola? |___|___|Horas |___|___|Min
Quantos televisores têm em sua casa?  1
2
O seu/sua filho/a tem televisão no quarto?  SIM
3
4
 >4
 NÃO
Tem computadores (fixos e portáteis) em sua casa?  SIM  NÃO Se sim, quantos _______
Tem videojogos (nitendo, playstation, wii, gameboy) em sua casa?  SIM  NÃO Se sim, quantos _______
 SIM
Durante as refeições a televisão está ligada e a atenção está centrada na televisão?
Acha que seu filho tem, neste momento, um Peso
Muito Baixo
Baixo
 NÃO
Ligeiramente Magro
Ligeiramente com excesso de peso Excesso Peso
Normal
Obesidade
Qual destas figuras é semelhante ao seu filho(a)?
1
2
3
4
5
6
7
1
2
3
4
5
6
7
(COLOQUE UM CIRCULO NO NUMERO QUE SE ENCONTRA ABAIXO DA FIGURA ESCOLHIDA)
-2 -
Organização do Sono (BISQ)
Por favor, coloque apenas uma resposta (a mais apropriada) em cada questão.
O seu filho/a dorme:  em quarto próprio  no quarto dos pais  na cama dos pais
 em quarto partilhado com o irmão(s)  OUTRO: _____________________
Em que posição o seu filho/a dorme a maior parte do tempo?  de barriga para baixo
 de lado
 de costas
Quanto tempo o seu filho/a dorme durante a NOITE
(entre as 19h da tarde e as 7h da manhã)?
|___|___|Horas |___|___|Min
Quanto tempo o seu filho/a dorme durante o DIA
(entre as 7h da manhã e as 19h da tarde)?
|___|___|Horas |___|___|Min
Quanto tempo durante a noite o seu filho/a está acordado
(entre as 22h da noite e as 6h da manhã)?
|___|___|Horas |___|___|Min
Quanto tempo é que o seu filho/a demora a adormecer?
|___|___|Horas |___|___|Min
A que horas o seu filho vai dormir?
|___|___|Horas |___|___|Min
Número de vezes o seu filho/a acorda por noite: ?  nunca acorda
 1 vez
Como é q o seu filho/a adormece?  enquanto toma o biberão  embalado
 na cama sozinho
Acha q o seu filho/a tem problemas de sono?
 2 vezes
 ≥3 vezes
 com ajuda
 na cama junto aos pais
 OUTRO: _______________
 problemas muito sérios
 pequenos problemas
 Não tem problemas
Escala de Regulação Emocional (ERRS)
Por favor, classifique o seu filho de acordo com as descrições abaixo, colocando um círculo no número mais
adequado. O número 4 que está sublinhado no centro representa o ponto médio no qual a criança se poderá situar
nesse item. Por favor esteja à vontade para usar todas as possíveis opções de resposta..
Não é
provavel
1. Depois de receber de alguém um presente que não
gosta, qual a probabilidade do seu filho fingir que
gosta do presente?
2. Depois de ver alguém tropeçar ou cair de uma
forma engraçada, qual a probabilidade do seu filho rir
à gargalhada?
3. Depois do seu filho comer algo que lhe sabe mal,
qual a probabilidade dele cuspir a comida ou reagir
negativamente?
4. Num contexto mais sério, como uma igreja ou um
funeral, qual a probabilidade do seu filho entender e
se comportar adequadamente à situação?
5. Se lhe for pedido para guardar um segredo (p. ex.,
não falar ao irmão sobre a festa de aniversário
surpresa), qual a probabilidade do seu filho manter o
segredo?
6. Qual a probabilidade do seu filho ajudar os outros
(p. ex., amigo / irmão) a manter um segredo de forma
a evitar um castigo? (p. ex., não contar à mãe que um
irmão partiu um vaso)
Muito
provavel
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
-3 -
CARACTERÍSTICAS DOS PAIS
PAI
IDADE
PESO ATUAL
MÃE
|___|___|ANOS
|___|___|ANOS
|___|___|___|,|___| KG
|___|___|___|,|___| KG
ALTURA ATUAL
|___|,|___|___| M
(COLOCAR O VALOR
FUMA?
SE SIM, FUMA DENTRO DE CASA?
|___|,|___|___| M
QUE ESTÁ NO BILHETE DE IDENTIDADE)
 SIM
 NÃO
 SIM
 NÃO
 SIM
 NÃO
 SIM
 NÃO
ANO ESCOLARIDADE PAI:
 1ª, 2ª, 3ª OU 4ª CLASSE
 10º, 11º OU 12º ANO
 5º OU 6ºANO
 7º, 8º OU 9º ANO
 BACHARELATO OU CURSO SUPERIOR
ANO ESCOLARIDADE M ÃE:
 1ª, 2ª, 3ª OU 4ª CLASSE
 10º, 11º OU 12º ANO
 5º OU 6ºANO
 7º, 8º OU 9º ANO
 BACHARELATO OU CURSO SUPERIOR
PROFISSÃO PAI: ____________________________________________________________________
PROFISSÃO M ÃE: ____________________________________________________________________
QUESTÕES RELACIONADAS COM A GRAVIDEZ:
Idade que tinha quando engravidou do/da seu/sua filho/a? _________
Quantos filhos tem? _______
Que idade têm? _____________________
Recorde-se da alimentação do bebé no 1ºano de vida, durante quanto tempo foi
amamentado, só com leite materno?
 Não foi amamentado _
 Foi amamentado: quanto tempo: ______ dias ou ______ semanas ou ______ meses
Em que altura (dias, meses ou semanas), lhe introduziu outro alimento, além leite materno?
______ dias ou ______ semanas ou ______ meses
Que alimento foi? (assinale com uma cruz)
 Leite de vaca  Leite de lata  Papas  Sopa  Outro: Qual? ______________
Qual o seu peso no início da Gravidez do seu filho? __________ Kg
e no final? _________ Kg
Quantos quilos no total, aumentou no seu peso, durante a gravidez? _________ Kg
Teve diabetes gestacional?
 Sim  Não
Teve pré-eclampsia?
 Sim  Não
(tensão arterial elevada)
Teve de alteração a sua alimentação durante a gravidez?  Sim  Não Se sim,motivo? ____________
O/A seu/sua filho/a nasceu com quantos meses ou semanas de gestação: __________ semanas (Ex: 38 semanas)
Tipo de Parto?
 Parto Normal
 Cesariana
Fumou durante a Gravidez?  Sim  Não Se Sim, quantos por dia? ______
Manteve ou reduziu o consumo de tabaco?________
-4 -
ACTIVIDADE FÍSICA HABITUAL DOS PAIS
Questionário Internacional de Atividade Física (IPAQ)
As questões que lhes vou colocar, referem-se à semana imediatamente anterior, considerando o tempo em que esteve fisicamente
ativo/a. Por favor, respondam a todas as questões, mesmo que não se considerem pessoas fisicamente ativas. Vou colocar-lhes
questões sobre as atividades desenvolvidas na vossa atividade profissional e nas vossas deslocações, sobre as atividades referentes
aos trabalhos domésticos e às atividades que efetuam no vosso tempo livre para recreação ou prática de exercício físico / desporto.
Ao responder às seguintes questões considerem o seguinte:
Atividades físicas vigorosas referem-se a atividades que requerem um esforço físico intenso que fazem ficar com a respiração
ofegante.
Atividades físicas moderadas referem-se a atividades que requerem esforço físico moderado e tornam a respiração um pouco
mais forte que o normal.
PAI
Q.1 Diga-me por favor, nos últimos 7 dias, em quantos dias fez
atividades físicas vigorosas, como por exemplo, levantar objetos
pesados, cavar, correr, ginástica aeróbica, nadar, jogar
futebol/basquete, andar de bicicleta a um ritmo rápido, fazer
exercícios domésticos pesados (ex: esfregar o chão)?
MÃE
____ DIAS
Q.2 Nos dias em que pratica atividades físicas vigorosas pelo
menos 10 minutos seguidos, quanto tempo em média dedica
normalmente a essas atividades (por dia)?
____ HORAS
Q.3 Diga-me por favor, nos últimos 7 dias, em quantos dias fez
atividades físicas moderadas como por exemplo, carregar objetos
leves, caçar, ginástica manutenção, trabalhos de doméstico (ex:
varrer, aspirar, …), trabalhos de carpintaria, andar de bicicleta a
um ritmo normal ou ténis de pares? Por favor NÃO inclua o
“andar “.
Q.4 Nos dias em que faz atividades físicas moderadas pelo
menos 10 minutos seguidos, quanto tempo em média dedica
normalmente a essas atividades (por dia)?
____ DIAS
____ MIN.
____ HORAS
____ DIAS
____ HORAS
Q.5 Diga-me por favor, nos últimos 7 dias, em quantos dias andou
pelo menos 10 minutos seguidos em casa ou no trabalho, por
lazer, por prazer ou como exercício?
____ DIAS
____ MIN.
____ HORAS
____ DIAS
Q.6 Quanto tempo no total, despendeu num desses dias, a
andar/caminhar?
Q.7 Diga-me por favor, num dia normal da semana quanto tempo
passa sentado? Isto pode incluir o tempo que passa a uma
secretária (estudar, computador), a visitar amigos, a ler, a
estudar, a brincar com os filhos, a ver televisão.
(some todos os momentos)
____ MIN.
____ MIN.
____ DIAS
____ HORAS
____ MIN.
____ HORAS
____ MIN.
____ HORAS
____ MIN.
____ HORAS
____ MIN.
ACTIVIDADE FÍSICA ORGANIZADA DOS PAIS
Pai
Pratica regularmente Atividade Física
 Sim
organizada?
Sim...
Se,
Tipo de atividade
Mãe
 Não
 Sim
______________________
 Não
______________________
Horas por semana
<1h
1-2h
2-3h
3-4h
>4h
<1h
1-2h
2-3h
3-4h
>4h
Duração de cada sessão
<1h
1-2h
2-3h
3-4h
>4h
<1h
1-2h
2-3h
3-4h
>4h
Código Postal da sua área de residência: ___________ - ______
Muito Obrigada pela Colaboração
-5 -
Appendix 2: Informed consent
RUA DR. PLÁCIDO COSTA, 91
4200-450 PORTO. PORTUGAL
TELEFONE +351 225074700
FAX +351 225500689
O Futebol como uma nova abordagem terapêutica no combate
ao excesso de peso e obesidade pediátrica
CONSENTIMENTO INFORMADO
Eu, abaixo-assinado, ___________________________________________________________,
na qualidade de representante legal do educando_____________________________________
_______________________,fui informado de que o estudo de investigação acima mencionado
se destina a avaliar a influência da prática de futebol em indicadores cardiometabólicos, na
aptidão física e no bem-estar psicológico de crianças. Tomei conhecimento que irá ser oferecida,
de forma gratuita, a oportunidade de praticar exercício físico regular sob a orientação de
profissionais. Sei que está prevista a realização de duas avaliações, no início e no final do
estudo, relacionadas com a aptidão física e a saúde, que incluem:
a) Colheita de sangue (9 mL) por punção venosa. A colheita de sangue permitirá realizar a
avaliação de diversos marcadores de risco cardiometabólico pelo que os participantes
beneficiarão de um estudo analítico mais alargado, através do seu médico responsável.
Alguns dos estudos que vão ser efectuados são estudos genéticos, respeitando o
estabelecido no Decreto-Lei 12/2005, de 26 de Janeiro. No caso de serem descobertos
dados relevantes será facultada aos participantes a possibilidade de os conhecer e de ter
o devido aconselhamento médico e acompanhamento psicológico. Sei que uma parte do
sangue vai ser utilizada de imediato para fazer algumas análises e que outra parte vai
ser armazenada (cerca de dois anos) para ser analisada posteriormente;
b) Avaliação da composição corporal e da densidade mineral óssea através da medição do
perímetro da cintura, e recorrendo a uma balança de bio-impedância e densitometria
(DXA). O DXA apesar de emitir radiação (Raio-x), a sua dosagem é extremamente
reduzida, equivalendo a um dia de exposição solar normal, não havendo qualquer
contraindicação de aplicação em crianças a partir dos 3 anos de idade;
c) Avaliação do estádio maturacional através da escala de Tanner;
d) Medidas de pressão arterial, frequência cardíaca e variabilidade cardíaca em repouso;
e) Avaliação do volume de oxigénio máximo (VO2máx) avaliado através de um protocolo de
exercício incremental num tapete rolante.
Foi-me garantido que todos os dados relativos à identificação dos participantes neste estudo
são confidenciais e que a utilização das amostras será apenas no âmbito do estudo.
Sei que posso recusar-me a autorizar a participação ou interromper a qualquer momento a
participação no estudo do menor de idade de que sou responsável, sem nenhum tipo de
penalização por este facto. Compreendi a informação que me foi dada, tive oportunidade de
fazer perguntas e as minhas dúvidas foram esclarecidas.
Autorizo de livre vontade a participação daquele que legalmente represento no estudo acima
mencionado. Concordo que sejam efetuados os exames e a colheita de amostras de sangue
para realizar as análises que fazem parte deste estudo. Também autorizo a divulgação dos
resultados obtidos no meio científico, garantindo o anonimato.
Assinatura______________________________Data[Ano/mês/dia]20__/____/____.
Appendix 3: Children’s attraction to physical activity
questionnaire (CAPA)
Atração para a Atividade Física
Item
Exactamente
como eu
Como
eu
1


2


3


4


5


6


7


8


Alguns alunos não gostam de ficar com falta de ar
depois de se esforçarem muito a jogar
9


10


11


12


13


14


Alguns alunos pensam que é muito importante
estar sempre em boa forma
Para alguns alunos jogos e desportos são a sua
atividade favorita
Alguns alunos são mais conhecidos entre outros
alunos quando praticam jogos e desportos
Alguns alunos estão sempre desejosos de praticar
jogos e desportos
Alguns alunos não gostam mesmo de praticar
jogos e desportos
Alguns alunos sentem-se mal quando correm
muito rápido
Alguns alunos divertem-se mais a jogar ou a
praticar desportos do que a fazer outras coisas
Alguns alunos não gostam muito de praticar jogos
e desportos
Alguns alunos têm colegas que lhes dizem que
eles não são muito bons a praticarem jogos e
desportos
Alguns alunos são gozados por outros quando
praticam jogos e desportos
Alguns alunos pensam que quantos mais jogos e
desportos fizerem melhor
Alguns alunos não gostam muito de praticar jogos
e desportos
Alguns alunos não gostam muito de correr
Exactamente
como eu
Como
eu
MAS
Outros alunos gostam mais de fazer outras coisas


MAS
Outros alunos gostam muito de praticar jogos e
desportos


MAS
Outros alunos têm colegas que lhes dizem que
eles são bons a praticarem jogos e desportos


Outros alunos não são gozados por outros
quando praticam jogos e desportos
Outros alunos pensam que não é bom fazer
demasiados jogos e desportos
Outros alunos gostam muito de praticar jogos e
desportos
Outros alunos gostam muito de correr
Outros alunos não gostam de ficar cansados e
com falta de ar depois de se esforçarem muito a
jogar
Outros alunos pensam que não é assim tão
importante estar sempre em boa forma
Outros alunos gostam mais de outras atividades
do que de jogos e desportos
Alguns alunos não são tão populares entre
outros alunos quando praticam jogos e desportos
Outros alunos não estão sempre desejosos de
praticar jogos e desportos
Outros alunos gostam mesmo de praticar jogos e
desportos
Outros alunos sentem-se bem quando correm
muito rápido






















MAS
MAS
MAS
MAS
MAS
MAS
MAS
MAS
MAS
MAS
MAS
15


Alguns alunos esforçam-se muito para ter boa
forma
MAS
Outros alunos não se esforçam muito para ter
boa forma


Appendix 4: Quality of life questionnaire
Este 2 questionários enquadram-se no Projeto “Futebol é Saúde”, no
qual o seu filho/a está a participar.
Estimamos que, na sua totalidade, demore cerca de 20 minutos a ser
preenchido.
Obrigada pela atenção dispensada.
Quem preencheu o questionário:
 Mãe
 Pai
 Outro: _____________________
CARACTERÍSTICAS DO SEU/SUA FILHO/A:
Data de Nascimento |___|___|.|___|___|.|___|___|___|___|
dia
mês
ano
A que horas se deita:
A que horas se levanta:
Em média, num dia normal de
semana
|___|___|Horas |___|___|Min
|___|___|Horas |___|___|Min
Em média, num dia de fim-desemana
|___|___|Horas |___|___|Min
|___|___|Horas |___|___|Min
Em média, quanto tempo é que o seu filho passa a ver TV, jogar videojogos
e no computador?(some todos os momentos)
Num dia normal de semana
 <30min
 30 min
 1h
 2h
 3h
 >3h
Num dia de fim de semana
 <30min
 30 min
 1h
 2h
 3h
 >3h
De acordo com o Boletim de Saúde: (se preferir pode anexar uma fotocopia da página 2 e 3 do Boletim de Saúde Infantil e
Peso
Juvenil do seu filho(a))
Comprimento/Altura
à Nascença
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
1 ano
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
2 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
3 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
4 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
5 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
6 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
7 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
8 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
9 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
10 anos
|___|___|, |___|___|___| kg
|___|___|___|,___| cm
Pratica Atividade Física organizada fora da escola?
 Sim
 Não
Se Sim, qual/quais:
Tipo de Atividade
Exemplo:
Karaté
Nº de vezes por semana
Duração de cada sessão
1x
2x
3x
4x
5x
6x
7x
30`
45`
1h
1h30
1x
2x
3x
4x
5x
6x
7x
30`
45`
1h
1h30
1x
2x
3x
4x
5x
6x
7x
30`
45`
1h
1h30
1x
2x
3x
4x
5x
6x 7x
30`
45`
1h
1h30
Dia(s) da semana
Segunda e Sexta
Qual o transporte que utiliza para ir para a escola?
 carro
 autocarro
 mota
 a pé
 Outro:__________________
quanto tempo demora no percurso casa-escola? _____________ minutos
-1 -
Qual o seu tipo de habitação:
 apartamento
 moradia
 Outro:__________________________________
No local onde vive, é possível que o seu filho brinque no exterior?  SIM
Se Sim, onde?  na rua
 num parque junto à sua casa
Se não, qual o motivo?  não tem quintal/jardim em casa
 no quintal/jardim de casa
 a rua tem muito tráfego
 a rua é perigosa em termos criminais,
o meu/minha filho/a é naturalmente muito
ativo
o meu/minha filho/a precisa de mim para ter
motivação para brincar
o meu/minha precisa de companhia (amigos,
Irmãos, pais) para ter motivação para brincar
 NÃO
 no parque infantil
 não há parque infantil
Outro: ______________________________
NUNCA
RARAMENTE
OCASIONALMENTE
FREQUENTEMENTE
SEMPRE















Comparando com crianças da mesma idade, considera o seu/sua filho/a:
 MUITO MAIS ACTIVO
 MAIS ACTIVO
 IGUAL
 MENOS ACTIVO
 MUITO MENOS ACTIVO
O/A seu/sua filho/a com quem vive:  PAI  MÃE  IRMÃOS  AVÓ  AVÔ  OUTROS: _________________
Quantas horas por dia, o/a seu/sua filho/a passa na escola? |___|___|Horas |___|___|Min
Quantos televisores têm em sua casa?  1
2
O seu/sua filho/a tem televisão no quarto?  SIM
3
4
 >4
 NÃO
Tem computadores (fixos e portáteis) em sua casa?  SIM  NÃO Se sim, quantos _______
Tem videojogos (nitendo, playstation, wii, gameboy) em sua casa?  SIM  NÃO Se sim, quantos _______
 SIM
Durante as refeições a televisão está ligada e a atenção está centrada na televisão?
Acha que seu filho tem, neste momento, um Peso
Muito Baixo
Baixo
 NÃO
Ligeiramente Magro
Ligeiramente com excesso de peso Excesso Peso
Normal
Obesidade
Qual destas figuras é semelhante ao seu filho(a)?
1
2
3
4
5
6
7
1
2
3
4
5
6
7
(COLOQUE UM CIRCULO NO NUMERO QUE SE ENCONTRA ABAIXO DA FIGURA ESCOLHIDA)
-2 -
Organização do Sono (BISQ)
Por favor, coloque apenas uma resposta (a mais apropriada) em cada questão.
O seu filho/a dorme:  em quarto próprio  no quarto dos pais  na cama dos pais
 em quarto partilhado com o irmão(s)  OUTRO: _____________________
Em que posição o seu filho/a dorme a maior parte do tempo?  de barriga para baixo
 de lado
 de costas
Quanto tempo o seu filho/a dorme durante a NOITE
(entre as 19h da tarde e as 7h da manhã)?
|___|___|Horas |___|___|Min
Quanto tempo o seu filho/a dorme durante o DIA
(entre as 7h da manhã e as 19h da tarde)?
|___|___|Horas |___|___|Min
Quanto tempo durante a noite o seu filho/a está acordado
(entre as 22h da noite e as 6h da manhã)?
|___|___|Horas |___|___|Min
Quanto tempo é que o seu filho/a demora a adormecer?
|___|___|Horas |___|___|Min
A que horas o seu filho vai dormir?
|___|___|Horas |___|___|Min
Número de vezes o seu filho/a acorda por noite: ?  nunca acorda
 1 vez
Como é q o seu filho/a adormece?  enquanto toma o biberão  embalado
 na cama sozinho
Acha q o seu filho/a tem problemas de sono?
 2 vezes
 ≥3 vezes
 com ajuda
 na cama junto aos pais
 OUTRO: _______________
 problemas muito sérios
 pequenos problemas
 Não tem problemas
Escala de Regulação Emocional (ERRS)
Por favor, classifique o seu filho de acordo com as descrições abaixo, colocando um círculo no número mais
adequado. O número 4 que está sublinhado no centro representa o ponto médio no qual a criança se poderá situar
nesse item. Por favor esteja à vontade para usar todas as possíveis opções de resposta..
Não é
provavel
1. Depois de receber de alguém um presente que não
gosta, qual a probabilidade do seu filho fingir que
gosta do presente?
2. Depois de ver alguém tropeçar ou cair de uma
forma engraçada, qual a probabilidade do seu filho rir
à gargalhada?
3. Depois do seu filho comer algo que lhe sabe mal,
qual a probabilidade dele cuspir a comida ou reagir
negativamente?
4. Num contexto mais sério, como uma igreja ou um
funeral, qual a probabilidade do seu filho entender e
se comportar adequadamente à situação?
5. Se lhe for pedido para guardar um segredo (p. ex.,
não falar ao irmão sobre a festa de aniversário
surpresa), qual a probabilidade do seu filho manter o
segredo?
6. Qual a probabilidade do seu filho ajudar os outros
(p. ex., amigo / irmão) a manter um segredo de forma
a evitar um castigo? (p. ex., não contar à mãe que um
irmão partiu um vaso)
Muito
provavel
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
-3 -
CARACTERÍSTICAS DOS PAIS
PAI
IDADE
PESO ATUAL
MÃE
|___|___|ANOS
|___|___|ANOS
|___|___|___|,|___| KG
|___|___|___|,|___| KG
ALTURA ATUAL
|___|,|___|___| M
(COLOCAR O VALOR
FUMA?
SE SIM, FUMA DENTRO DE CASA?
|___|,|___|___| M
QUE ESTÁ NO BILHETE DE IDENTIDADE)
 SIM
 NÃO
 SIM
 NÃO
 SIM
 NÃO
 SIM
 NÃO
ANO ESCOLARIDADE PAI:
 1ª, 2ª, 3ª OU 4ª CLASSE
 10º, 11º OU 12º ANO
 5º OU 6ºANO
 7º, 8º OU 9º ANO
 BACHARELATO OU CURSO SUPERIOR
ANO ESCOLARIDADE M ÃE:
 1ª, 2ª, 3ª OU 4ª CLASSE
 10º, 11º OU 12º ANO
 5º OU 6ºANO
 7º, 8º OU 9º ANO
 BACHARELATO OU CURSO SUPERIOR
PROFISSÃO PAI: ____________________________________________________________________
PROFISSÃO M ÃE: ____________________________________________________________________
QUESTÕES RELACIONADAS COM A GRAVIDEZ:
Idade que tinha quando engravidou do/da seu/sua filho/a? _________
Quantos filhos tem? _______
Que idade têm? _____________________
Recorde-se da alimentação do bebé no 1ºano de vida, durante quanto tempo foi
amamentado, só com leite materno?
 Não foi amamentado _
 Foi amamentado: quanto tempo: ______ dias ou ______ semanas ou ______ meses
Em que altura (dias, meses ou semanas), lhe introduziu outro alimento, além leite materno?
______ dias ou ______ semanas ou ______ meses
Que alimento foi? (assinale com uma cruz)
 Leite de vaca  Leite de lata  Papas  Sopa  Outro: Qual? ______________
Qual o seu peso no início da Gravidez do seu filho? __________ Kg
e no final? _________ Kg
Quantos quilos no total, aumentou no seu peso, durante a gravidez? _________ Kg
Teve diabetes gestacional?
 Sim  Não
Teve pré-eclampsia?
 Sim  Não
(tensão arterial elevada)
Teve de alteração a sua alimentação durante a gravidez?  Sim  Não Se sim,motivo? ____________
O/A seu/sua filho/a nasceu com quantos meses ou semanas de gestação: __________ semanas (Ex: 38 semanas)
Tipo de Parto?
 Parto Normal
 Cesariana
Fumou durante a Gravidez?  Sim  Não Se Sim, quantos por dia? ______
Manteve ou reduziu o consumo de tabaco?________
-4 -
ACTIVIDADE FÍSICA HABITUAL DOS PAIS
Questionário Internacional de Atividade Física (IPAQ)
As questões que lhes vou colocar, referem-se à semana imediatamente anterior, considerando o tempo em que esteve fisicamente
ativo/a. Por favor, respondam a todas as questões, mesmo que não se considerem pessoas fisicamente ativas. Vou colocar-lhes
questões sobre as atividades desenvolvidas na vossa atividade profissional e nas vossas deslocações, sobre as atividades referentes
aos trabalhos domésticos e às atividades que efetuam no vosso tempo livre para recreação ou prática de exercício físico / desporto.
Ao responder às seguintes questões considerem o seguinte:
Atividades físicas vigorosas referem-se a atividades que requerem um esforço físico intenso que fazem ficar com a respiração
ofegante.
Atividades físicas moderadas referem-se a atividades que requerem esforço físico moderado e tornam a respiração um pouco
mais forte que o normal.
PAI
Q.1 Diga-me por favor, nos últimos 7 dias, em quantos dias fez
atividades físicas vigorosas, como por exemplo, levantar objetos
pesados, cavar, correr, ginástica aeróbica, nadar, jogar
futebol/basquete, andar de bicicleta a um ritmo rápido, fazer
exercícios domésticos pesados (ex: esfregar o chão)?
MÃE
____ DIAS
Q.2 Nos dias em que pratica atividades físicas vigorosas pelo
menos 10 minutos seguidos, quanto tempo em média dedica
normalmente a essas atividades (por dia)?
____ HORAS
Q.3 Diga-me por favor, nos últimos 7 dias, em quantos dias fez
atividades físicas moderadas como por exemplo, carregar objetos
leves, caçar, ginástica manutenção, trabalhos de doméstico (ex:
varrer, aspirar, …), trabalhos de carpintaria, andar de bicicleta a
um ritmo normal ou ténis de pares? Por favor NÃO inclua o
“andar “.
Q.4 Nos dias em que faz atividades físicas moderadas pelo
menos 10 minutos seguidos, quanto tempo em média dedica
normalmente a essas atividades (por dia)?
____ DIAS
____ MIN.
____ HORAS
____ DIAS
____ HORAS
Q.5 Diga-me por favor, nos últimos 7 dias, em quantos dias andou
pelo menos 10 minutos seguidos em casa ou no trabalho, por
lazer, por prazer ou como exercício?
____ DIAS
____ MIN.
____ HORAS
____ DIAS
Q.6 Quanto tempo no total, despendeu num desses dias, a
andar/caminhar?
Q.7 Diga-me por favor, num dia normal da semana quanto tempo
passa sentado? Isto pode incluir o tempo que passa a uma
secretária (estudar, computador), a visitar amigos, a ler, a
estudar, a brincar com os filhos, a ver televisão.
(some todos os momentos)
____ MIN.
____ MIN.
____ DIAS
____ HORAS
____ MIN.
____ HORAS
____ MIN.
____ HORAS
____ MIN.
____ HORAS
____ MIN.
ACTIVIDADE FÍSICA ORGANIZADA DOS PAIS
Pai
Pratica regularmente Atividade Física
 Sim
organizada?
Sim...
Se,
Tipo de atividade
Mãe
 Não
 Sim
______________________
 Não
______________________
Horas por semana
<1h
1-2h
2-3h
3-4h
>4h
<1h
1-2h
2-3h
3-4h
>4h
Duração de cada sessão
<1h
1-2h
2-3h
3-4h
>4h
<1h
1-2h
2-3h
3-4h
>4h
Código Postal da sua área de residência: ___________ - ______
Muito Obrigada pela Colaboração
-5 -
Appendix 5: Self-esteem questionnaire
Rosenber M (1965) Society and the adolescente self-image.
Princeton NJ: Princeton University Press
Preencha as questões (itens) utilizando a seguinte escala:
1
2
3
Discordo
completamente
4
Concordo
1. No geral, estou satisfeito comigo próprio (a).
1
2
3
4
2. Às vezes penso que não valho nada.
1
2
3
4
3. Sinto que tenho bastantes qualidades.
1
2
3
4
4. Sou capaz de fazer coisas tão bem como as outras pessoas.
1
2
3
4
5. Sinto que não tenho muito para me sentir orgulhoso (a).
1
2
3
4
6. Por vezes, sinto-me um (a) inútil.
1
2
4
3
7. Sinto que sou uma pessoa digna, pelo menos num nível igual ao das outras pessoas.
1
2
3
4
8. Desejava ter mais respeito por mim próprio (a).
1
2
3
4
9. Em geral, a minha vida leva-me a sentir que sou um fracasso.
1
2
3
4
10. Tomo atitudes positivas em relação a mim próprio (a).
1
2
3
4
Appendix 6: Self perception profile for children
questionnaire
Versão Portuguesa do
Self Perception Profile for Children
~
Versão Original de Susan Harter (1984)
Adaptação de Castro, Monteiro, Rebelo e Sá (1992)
Instruções
Na página seguinte está uma lista de situações. Por favor diz-nos a tua opinião
sobre cada uma delas. Seguidamente tens um exemplo, para te ajudar a compreender a
prova.
Não há respostas correctas ou incorrectas.
Se não entendes uma pergunta, por favor pede ajuda
Exemplo:
Sou
mesmo
assim
Sou
mais ou
menos
assim
Sou
mais ou
menos
assim
Alguns adolescentes nos
seus
tempos
livres
preferem brincar fora de
casa
MAS
Outros
adolescentes
preferem ver televisão
Sou
mesmo
assim
Como é que eu sou?
Sou
mesmo
assim
Sou mais
ou
menos
assim
Sou mais
ou
menos
assim
1.
Algumas crianças
acham que são
muito boas a fazer o
trabalho da escola
Outras crianças muitas
vezes duvidam se
conseguirão fazer o
trabalho da escola
2.
Algumas crianças
acham difícil fazer
amigos
Outras crianças acham
bastante fácil fazer
amigos
3.
Algumas crianças
são muito boas em
todo o tipo de
desportos
Outras crianças não se
acham muito boas no
desporto
4.
Algumas crianças
estão satisfeitas
com a sua aparência
Outras crianças não
estão satisfeitas com a
sua aparência
5.
Algumas crianças
não gostam da
forma como se
comportam
Outras crianças
geralmente gostam da
forma como se
comportam
6.
Algumas crianças
nunca estão
satisfeitas consigo
Outras crianças
geralmente estão
satisfeitas consigo
7.
Algumas crianças
acham que são tão
espertas como os da
sua idade
Algumas crianças
têm muitos amigos
Outras crianças duvidam
se serão tão espertas
como as da sua idade
Algumas crianças
gostavam de ser
melhores no
desporto
Algumas crianças
estão satisfeitas
com a altura e o
peso que têm
Outras crianças acham
que são suficientemente
boas no desporto
8.
9.
10.
Outras crianças não têm
muitos amigos
Outras crianças
gostavam de ter uma
altura ou peso diferente
Sou
mesmo
assim
Como é que eu sou?
Sou
mesmo
assim
Sou
mais ou
menos
assim
Sou
mais ou
menos
assim
11.
Algumas crianças
quase sempre fazem
aquilo que devem
Outras crianças quase
nunca fazem aquilo que
devem
12.
Algumas crianças não
gostam da forma como
a vida lhes corre
Outras crianças gostam
da forma como a vida
lhes corre
13.
Algumas crianças são
bastante lentas a fazer
os trabalhos de casa
Outras crianças
conseguem fazer o
trabalho da escola
depressa
14.
Algumas crianças
gostavam de ter mais
amigos
Outras crianças já têm
todos os amigos que
queriam
15.
Algumas crianças
acham que são
capazes de fazer à
primeira qualquer
desporto que nunca
tenham tentado
Outras crianças têm
receio de não se sair
bem em desportos que
nunca experimentaram
16.
Algumas crianças
gostariam que o seu
corpo fosse diferente
Outras crianças gostam
do seu corpo tal como é
17.
Algumas crianças
comportam-se quase
sempre de acordo com
o que se sabem que se
espera deles
Outras crianças quase
nunca se comportam da
forma que é esperada
18.
Algumas crianças
estão contentes
consigo próprias como
pessoas
Outras crianças quase
nunca estão contentes
consigo próprias
19.
Algumas crianças
esquecem muitas
vezes o que
aprenderam
Outras crianças
conseguem lembrar-se
das coisas com
facilidade
20.
Algumas crianças
fazem a maioria das
coisas com os amigos
Outras crianças
costumam fazer as
coisas sozinhas
Sou
mesmo
assim
Como é que eu sou?
Sou
mesmo
assim
Sou mais
ou
menos
assim
Sou mais
ou
menos
assim
21.
Algumas crianças
acham que são
melhores no desporto
do que os outros da
sua idade
Outras crianças
acham que não
conseguem ser tão
boas como os da sua
idade
22.
Algumas crianças
gostavam de ter uma
aparência física
diferente
Outras crianças
gostam da aparência
física que têm
23.
Algumas crianças
arranjam muitas vezes
problemas por causa
das coisas que fazem
Outras crianças não
fazem coisas que lhes
arranjem problemas
24.
Algumas crianças
gostam de ser como
são
Outras crianças
muitas vezes
gostariam de ser uma
pessoa diferente
25.
Algumas crianças são
muito bons alunos
Outras crianças não
são muito bons
alunos
26.
Algumas crianças
queriam que as
pessoas da sua idade
gostassem delas
Outras crianças
acham que a maior
parte das pessoas da
sua idade gosta delas
27.
Algumas crianças
geralmente ficam a
ver os jogos e
desportos, em vez de
jogarem
Outras crianças
geralmente entram
nos jogos, em vez de
ficarem apenas a ver
28.
Algumas crianças
gostavam que a sua
cara ou o seu cabelo
fossem diferentes
Outras crianças
gostam da cara e do
cabelo que têm
29.
Algumas crianças
fazem coisas que
sabem que não deviam
fazer
Outras crianças
quase nunca fazem
coisas que sabem que
não deviam fazer
30.
Algumas crianças são
muito felizes sendo
como são
Outras crianças
gostavam de ser
diferentes
Sou
mesmo
assim
Como é que eu sou?
Sou
mesmo
assim
Sou mais
ou
menos
assim
Sou mais
ou
menos
assim
31.
Algumas crianças têm
dificuldade em
descobrir as respostas
às perguntas feitas na
aula
Outras crianças
conseguem quase
sempre descobrir as
respostas
32.
Algumas crianças são
populares entre os da
sua idade
Outras crianças não
são muito populares
33.
Algumas crianças não
são boas nos jogos de
ar livre que não
conhecem
Outras crianças
fazem logo bem os
jogos novos
34.
Algumas crianças
acham-se bonitas
Outras crianças não
se acham muito
bonitas
35.
Algumas crianças
comportam-se muito
bem
Outras crianças
muitas vezes acham
difícil comportaremse bem
36.
Algumas crianças
nunca estão satisfeitas
com a forma como
fazem as coisas
Outras crianças
acham que fazem
bem as coisas
Sou
mesmo
assim
Castro, P., Sá, I., Monteiro, M. B., & Rebelo, M. (1992). Perfil de auto-percepção para crianças: Estudo
de um instrumento de avaliação da auto-estima. Comunicação apresentada no III Simpósio de
Investigação em Psicologia. Lisboa, Fundação Calouste Gulbenkian.
Appendix 7: Cardiorespiratory fitness report
Nome:
Apelido:
Identificação:
Data Nasc.:
Sexo:
Idade:
Altura:
Peso:
IMC:
Protocol:
Time:
Time
min
00:04
00:10
00:15
00:20
00:25
00:30
00:35
00:40
00:45
00:50
00:55
01:00
01:05
01:10
01:15
01:20
01:25
01:30
01:35
01:40
01:45
01:50
01:55
02:00
02:05
02:10
02:15
02:20
02:25
02:30
02:35
02:40
02:45
02:50
02:55
03:00
03:05
03:10
03:15
03:20
03:25
03:30
03:35
03:40
03:45
03:50
03:55
04:00
04:05
04:10
04:15
04:20
04:25
04:30
04:35
04:40
04:45
Diogo
Leão
UEFAPER13/1440
16-09-2002
male
11 Years
156,2 cm
61,6 kg
25,25
TM_ACORDA
11:17:20
Speed
km/h
Elev.
%
0.0
0.0
0.0
1.0
2.3
3.6
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.0
4.6
5.8
6.3
7.8
7.9
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
V'CO2
ml/min
V'O2
ml/min
387
239
320
402
347
459
310
454
410
638
510
536
532
579
550
612
548
610
592
575
604
555
605
654
498
565
583
650
564
524
672
533
626
695
549
601
431
509
753
645
691
726
855
894
843
1236
1041
1152
1251
1345
1252
1371
1411
1351
1561
1458
1575
512
310
420
508
453
600
409
643
588
907
691
731
737
796
715
876
782
892
804
745
795
740
812
865
666
799
794
896
755
732
900
720
864
969
761
824
595
749
1038
922
980
997
1166
1323
1151
1675
1360
1491
1538
1669
1543
1667
1693
1627
1893
1718
1820
Date:
VO2/kg
ml/
min/kg
8.3
5.0
6.8
8.2
7.3
9.7
6.6
10.4
9.5
14.7
11.2
11.9
12.0
12.9
11.6
14.2
12.7
14.5
13.1
12.1
12.9
12.0
13.2
14.0
10.8
13.0
12.9
14.5
12.3
11.9
14.6
11.7
14.0
15.7
12.3
13.4
9.7
12.2
16.9
15.0
15.9
16.2
18.9
21.5
18.7
27.2
22.1
24.2
25.0
27.1
25.1
27.1
27.5
26.4
30.7
27.9
29.5
03-03-2014
RER
HR
1/min
BF
1/min
V'E
L/min
0.75
0.77
0.76
0.79
0.77
0.76
0.76
0.71
0.70
0.70
0.74
0.73
0.72
0.73
0.77
0.70
0.70
0.68
0.74
0.77
0.76
0.75
0.74
0.76
0.75
0.71
0.73
0.73
0.75
0.72
0.75
0.74
0.72
0.72
0.72
0.73
0.72
0.68
0.72
0.70
0.71
0.73
0.73
0.68
0.73
0.74
0.77
0.77
0.81
0.81
0.81
0.82
0.83
0.83
0.82
0.85
0.87
0
85
79
85
85
97
98
111
105
105
109
108
108
106
109
107
107
116
114
109
106
105
106
109
101
101
107
106
105
105
109
106
111
107
110
103
103
102
109
106
112
126
147
146
144
147
156
147
173
165
172
163
173
170
170
172
172
24
14
17
14
21
19
21
16
23
22
22
26
25
26
19
20
28
29
32
22
25
22
25
25
20
28
25
24
24
21
24
26
32
33
22
21
21
19
24
35
39
26
24
48
30
39
41
45
44
32
39
40
41
36
43
47
41
14
10
12
16
14
18
13
16
16
25
20
21
21
22
21
21
22
24
24
22
24
21
23
25
19
22
24
24
23
19
26
22
26
28
20
23
17
17
30
25
30
28
31
36
32
49
42
47
51
50
49
55
57
53
62
61
65
Time
min
04:50
04:55
05:00
05:05
05:10
05:15
05:20
05:25
05:30
05:35
05:40
05:45
05:50
05:55
06:00
06:05
06:10
06:15
06:20
06:25
06:30
06:35
06:40
06:45
06:50
06:55
07:00
07:05
07:10
07:15
07:20
07:25
07:30
07:35
07:40
07:45
07:50
07:55
08:00
08:05
08:10
08:15
08:20
08:23
08:25
08:30
08:35
08:40
08:45
08:50
Summary
Speed
km/h
Elev.
%
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
8.0
6.5
5.6
5.0
4.1
0.0
0.0
0.0
0.0
0.0
2.2
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
3.0
5.2
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
6.0
5.4
1.3
0.0
0.0
0.0
V'CO2
ml/min
V'O2
ml/min
1534
1519
1498
1571
1545
1581
1595
1511
1295
1647
1585
1630
1633
1670
1691
1634
1647
1744
1890
1809
1879
1534
1834
1789
1820
1840
1943
1871
1726
1787
1841
1851
2039
2050
2125
2132
2080
2129
2006
2067
1724
2055
2098
1933
1840
1876
1820
1485
1319
1065
1790
1786
1770
1808
1806
1821
1828
1738
1530
1943
1828
1875
1853
1881
1861
1832
1901
1947
2082
1961
2077
1724
2061
1994
2037
2018
2129
2049
1940
1972
2037
2128
2229
2194
2248
2216
2172
2230
2112
2156
1907
2182
2193
2004
1945
1983
1931
1621
1474
1193
MaxVO2
Time averaging 5 Seconds
Time
min
07:40
Speed
km/h
8.0
Elev.
%
6.0
V'CO2
ml/min
2125
V'O2
ml/min
2248
VO2/kg
ml/min/kg
36.5
RER
0.95
HR
1/min
195
BF
1/min
51
V'E
L/min
96
AE
VO2/kg
ml/
min/kg
29.1
29.0
28.7
29.4
29.3
29.6
29.7
28.2
24.8
31.5
29.7
30.4
30.1
30.5
30.2
29.7
30.9
31.6
33.8
31.8
33.7
28.0
33.5
32.4
33.1
32.8
34.6
33.3
31.5
32.0
33.1
34.5
36.2
35.6
36.5
36.0
35.3
36.2
34.3
35.0
31.0
35.4
35.6
32.5
31.6
32.2
31.4
26.3
23.9
19.4
RER
HR
1/min
BF
1/min
V'E
L/min
0.86
0.85
0.85
0.87
0.86
0.87
0.87
0.87
0.85
0.85
0.87
0.87
0.88
0.89
0.91
0.89
0.87
0.90
0.91
0.92
0.90
0.89
0.89
0.90
0.89
0.91
0.91
0.91
0.89
0.91
0.90
0.87
0.91
0.93
0.95
0.96
0.96
0.95
0.95
0.96
0.90
0.94
0.96
0.96
0.95
0.95
0.94
0.92
0.89
0.89
170
176
187
177
178
179
181
177
184
179
178
178
182
185
187
182
186
185
189
188
187
190
186
190
189
188
190
191
192
192
192
193
191
194
195
193
194
195
196
198
193
194
192
191
182
190
189
186
183
180
46
45
49
45
46
44
45
39
28
38
40
46
42
46
42
53
38
48
48
44
45
32
46
43
44
49
46
48
44
45
45
41
52
51
51
50
50
54
52
51
35
45
49
46
44
43
41
29
28
25
65
63
63
66
63
66
68
62
47
65
64
68
68
70
70
67
66
75
80
76
80
56
74
74
74
80
82
84
67
76
76
77
91
91
96
97
95
97
91
93
68
88
95
86
80
82
77
57
46
41
AT
Vslope
AT
%VO2m
03:35
7.9
0.0
855
1166
18.9
0.73
147
24
31
98
0
40
52
52
78
75
46
32
VO2/kg
ml/min/kg
100
R
T AT
R
80
60
40
20
0
0
5
10
Time min
15
20
Appendix 8: Body composition report
CENTRO DE INVESTIGAÇÃO ACTIVIDADE FíSICA SAÚDE E LAZER
R. DR PLÁCIDO COSTA, 91
4200- 450, PORTO
Telephone: 225074700/ 68
E-Mail: [email protected]
Name: LEAO, DIOGO
Patient ID: 220024
DOB: 16 September 2002
Fax: 225500689
Sex: Male
Ethnicity: Pediatric
Height: 155.0 cm
Weight: 60.7 kg
Age: 11
Referring Physician: UEFA
Scan Information:
Scan Date: 03 March 2014
ID: A0303140C
Scan Type: e Lumbar Spine
Analysis: 03 March 2014 18:55 Version 13.2
Lumbar Spine (auto low density)
Operator:
Model:
Explorer (S/N 90365)
Comment:
DXA Results Summary:
Region
L1
L2
L3
L4
Total
116 x 118
DAP: 2.5 cGy*cm²
T-score vs. Pediatric Male; Z-score vs. Pediatric Male. Source:Hologic, 2005
Area
(cm²)
11.26
12.12
13.79
13.56
50.73
BMC BMD
(g) (g/cm²)
5.29 0.470
6.96 0.575
8.42 0.611
8.37 0.618
29.05 0.573
Total BMD CV 1.0%
WHO Classification: Osteoporosis
Fracture Risk: High
Comment:
Tscore
-4.7
-3.9
-3.9
-3.7
-4.4
PR
(%)
45
52
54
56
52
Zscore
-1.5
-1.0
-0.8
-0.6
-1.0
AM
(%)
76
87
89
92
86
Appendix 9: Final children report
Identificação
Nome:
Data de Nascimento:
Idade:
Diogo Leão
16/set/2002
Data de Avaliação: 02/09/2013
Sexo: M
11
Resultados dos Exames
Indicadores Somáticos
Resultado
Valores de Referência
Altura (cm):
145.8
> P95
Peso (kg):
50.7
> P95
Mensagens
< 19.10 - Normal
Índice de massa corporal (IMC)
19.11-22.77 - Sobrepeso
> 22.78 - Obesidade
23.9
Massa gorda total (%)
20-25 - Sobrepeso
> 25 - Obesidade
41.3
Massa gorda (kg)
20.9
Massa magra (kg)
29.7
Conteúdo mineral ósseo (g)
Densidade mineral óssea (g/cm2)
Consumo energético total
(Kcal) = 2131
Nutrição
Composição Corporal
< 20 - Normal
1330.21
Fat
0.878
Proteinas (%)
15.7
15-30
Hidratos de carbono (%)
56.3
55-75
Açucar (%)
17.3
<10
Gordura total (%)
28.0
15-30
Gorduras saturadas
7.7
<10
Gorduras mono-saturadas (%)
9.8
<9
Gorduras poli-saturadas (%)
5.3
6-10
Trans (%)
0.0
<1
>25
Colesterol (mg/dia)
21.9
,
181.6
Perímetro da Cintura (cm)
83.0
< 63.2
Triglicerídeos (mg/dl)
77,0
≤150
Colesterol HDL (mg/dl)
43.5
>40
Glicose (mg/dl)
63,0
,
≤100
113-50
< 117-76
Fibras (g/dia)
Lean
Bone
<300
Síndrome Metabólica
s
Tensão Arterial Sist / Diast (mm Hg)
Actividade
Física
saudável < 88 <
Dispêndio Energético
(Kcal)
Semana
Fim Semana
Média
246
243
245
Mod/Vig (min)
97
107
101
Passos
7328
7286
7311
É recomendável realizar diariamente 60 minutos de actividades
físicas/desportivas de intensidade moderada a vigorosa. São também
recomendados 11000 passos diários.

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